Case ReportSuccessful primary repair of late diagnosed spontaneous esophageal rupture: A case report

- Diagnosis of spontaneous rupture of the esophagus is often delayed.
- Significant contamination of the mediastinum and pleural space is not uncommon.
- Debridement and drainage of the mediastinum and pleural space are necessary to control sepsis.
- Debridement of necrotic tissue is necessary.
- Primary repair in layers of the esophagus is possible in majority of the cases regardless of the time lapsed from rupture.

IntroductionSpontaneous esophageal rupture is rare, roughly 300 cases reported annually. Diagnosis is often delayed or missed. Overall mortality is about 20%. This feared high mortality rate has led to the misconception that primary esophageal repair should be avoided in late diagnosed patients. We report a successful primary repair of spontaneous esophageal rupture which was delayed for more than two weeks.MethodsA 53 year-old male presented to our medical service after falsely having been treated for pneumonia at an outside hospital. He was subsequently diagnosed with spontaneous esophageal rupture and treated with over the scope clips followed by stenting. Persistent leak into mediastinum made surgical exploration necessary. At exploration a primary repair could be performed successfully.ResultsUnsuccessful endoscopic management of esophageal perforation that was delayed for two weeks underwent primary surgical repair without complications.ConclusionPrimary closure of late diagnosed spontaneous esophageal rupture can be successful, even when it is complicated by a prolonged delay in treatment and failed endoscopic procedures. We conclude that primary surgical repair should be attempted in patients with spontaneous esophageal rupture if tissues are viable.