A case of spontaneous esophageal rupture treated with conservative therapy

A 51 year-old male was admitted because of abrupt hematemesis and loss of consciousness. Emergency endoscopy depicted a giant esophageal ulcer on the left side extending from the middle intrathoracic region to the lower intrathoracic region. Esophagography, performed on the second day of admission, revealed a huge cavity (10 cm x 7 cm) filled with contrast medium resulting from a rupture in the ulceration. His state of shock improved with conservative therapy and no severe mediastinitis was noted. The drainage from the cavity into the lumen of the esophagus was considered to be acceptable from esophagography and an endoscopic examination. Secondary to his stable condition and continuous drainage, this patient was treated conservatively throughout his clinical course. The patient was given intravenous hyperalimentation (IVH) until the 25th hospital day and was medicated with broad spectrum-antibiotics. On the 21st hospital day the size of the esophageal cavity was markedly decreased (7 cm x 2 cm). Only small irregular mucosa was noted on the esophagogram taken 6 weeks after admission. Six months after the onset, an X-ray examination revealed complete healing of the spontaneous esophageal rupture with no recurrence.