[A case of mediastinitis caused by rupture of esophageal diverticulum]

A 42-year-old male student from abroad visited a department of internal medicine of a hospital because of fever and dyspnea. A diagnosis of purulental mediastinitis with empyema was made. After drainage of the right thoracic cavity, the patient was referred to our department. Although consecutive treatment consisting of administration of antibiotics and thoracic drainage was conducted, dyspnea became worse, and widening of the mediastinum become severer. Mediastinal drainage was done via the parasternal approach under general anesthesia. Thereafter, the patient temporarily suffered from respiratory failure, and controlled respiration by a respirator was needed. Since the amount of discharge from the mediastinal and thoracic drains gradually decreased, and clinical symptoms disappeared, the drain tubes were removed. During the clinical course, laryngoscopy, bronchoscopy, esophago-gastro-endoscopic examination and esophagography were performed. Esophagoscopy revealed a diverticulum, and esophagography showed a fistula from the esophageal diverticulum to mediastinum. From these examination results, a diagnosis of mediastinitis caused by rupture of esophageal diverticulum was established.