Emergency endoscopic observation in a case of spontaneous rupture of the esophagus.

Abstract

A 47-year-old male was admitted because of severe chest pain after repeated vomiting. A little amount of coffeegrounds was seen in the vomitus, and emergency endoscopic examination was performed 1 hour after the onset of symptoms. Endoscopy demonstrated a lacerated wound about 3 cm long on each side of the terminal esophagus. With a diagnosis of spontaneous rupture of the esophagus, a primary closure of the rupture was performed 4 hours after the onset, and a pedicled omental graft was applied over the suture site. The patient was discharged in improved condition on the 99th day. In Japan, more than 250 cases of spontaneous rupture of the esophagus have been reported, and 59 cases (including ours) have been observed endoscopically. Many authors have said that emergency endoscopy is useful for definitive diagnosis and for selection of the appropriate surgical procedure. The diagnostic accuracy with emergency endoscopy is 58 percent, so it has been suggested that emergency endoscopy is a valuable initial examination, but systematic diagnosis is necessary for early establishment of correct diagnosis.