[A case of accidental pneumatic rupture of the esophagus]

A case of pneumatic esophageal rupture secondary to distension from compressed air was reported. The patient, a 69-year-old man who was repairing an automobile tire suddenly exploded. The blast was directed into the open mouth. He was admitted to our hospital 12 hours after the onset with the complaint of chest pain and dyspnea. Subcutaneous emphysema was seen in the neck. The chest roentgenogram revealed a partial right hydropneumothorax. The diagnosis of esophageal rupture was established by Gastrographin swallowing study. Operation was performed 46 hours after the onset. Primary closure of the middle thoracic esophagus was judged to be impossible because of a 6 cm longitudinal laceration with contaminated pyothorax. Thereafter, total esophagectomy was indicated. Esophageal reconstruction using the pediculated gastric tube was performed throughout the retrosternal route. The leakage of esophagogastrostomy in the cervical area occurred in early postoperative stage. Re-esophagogastrostomy was successfully carried out 6 weeks after the first surgery. He is uneventful 6 months after the operation. We have not found any reports of surgical cases with pneumatic esophageal rupture treated by this approach in the literature.