Case Report: Two-stage surgical management of spontaneous oesophageal rupture with extensive necrosis

Spontaneous oesophageal rupture is a rare and life-threatening condition requiring urgent intervention. Management is particularly challenging when the rupture is accompanied by extensive transmural necrosis and severe thoracic contamination. We report a male patient in his late 30s who underwent emergency treatment approximately 11 h after symptom onset and was found to have an 8-cm full-thickness oesophageal tear with extensive transmural necrosis. Given the severe mediastinal and thoracic contamination and marked friability of the oesophageal wall, primary repair was considered unsuitable. A staged surgical strategy was therefore adopted. Stage I involved resection/exclusion of the damaged thoracic oesophagus with cervical oesophageal exteriorisation, gastrostomy for gastric drainage and decompression, and jejunostomy for enteral nutritional support. Stage II, performed 4 months later, consisted of gastrointestinal reconstruction using a retrosternal gastric conduit. During the 18-month follow-up, the patient resumed unrestricted oral intake and showed favourable nutritional and functional recovery. This case suggests that a staged surgical strategy may represent a feasible treatment option in carefully selected patients with severe Boerhaave syndrome when secure primary repair is precluded by extensive oesophageal necrosis and severe thoracic contamination.