[Surgical Techniques of Spontaneous Esophageal Rupture]

Spontaneous esophageal rupture was first reported by Boerhaave in 1724 and typically occurs in conjunction with vomiting, retching, or swallowing a large food bolus. This condition is potentially life threatening and causes severe mediastinitis, empyema, and sepsis, unless appropriate and early treatment is initiated. Conventional surgical repair is recommended within 24 hours of initial onset. However, some reports recommend surgery regardless of the time interval since onset. Various surgical procedures, conservative to esophagectomy, have been utilized in clinical practice. These methods include open thoracotomy, thoracoscopic surgery, or the addition of laparotomy. In this chapter the basic method of chest drainage, esophageal repair and reinforcement of suture line by open thoracotomy or thoracoscopic surgery. Surgical results for the treatment of this condition with thoracoscopic surgery are similar to those with conventional thoracotomy. Any procedures should be considered as suitable when selecting the approach used to treat Boerhaave's syndrome with regard to patient condition, status of the esophageal tear, and the surgeon's skills. In any surgical methods, it is important to assess the area of esophageal tear, to suture the esophageal wall appropriately, and to have enough drainage and place chest tubes in the proper position.