A patient with spontaneous rupture of the esophagus and concomitant gastric cancer whose life was saved: case of report
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
A patient with spontaneous rupture of the esophagus and concomitant gastric cancer whose life was saved: case of report and review of the literature in Japan Nobuhisa Matsuhashi1*, Narutoshi Nagao1, Chihiro Tanaka1, Takuo Nishina1, Masahiko Kawai1, Katsuyuki Kunieda1 and Hitoshi Iwata2
Abstract A 71-year-old man suddenly developed abdominal pain and vomiting on drinking soda after a meal, and visited a physician. Cervical subcutaneous and mediastinal emphysemas were observed on CT, and the patient was transferred to the emergency medical center of our hospital on the same day. Esophagography was performed at our department. A ruptured region was identified on the left side of the lower thoracic esophagus, and surgery was emergently performed employing sequential left thoracoabdominal incision. The chest wall was adhered due to inflammation, and large amounts of residual food and sloughing were present in the thoracic cavity and mediastinum. Moreover, necrotic changes were noted in the superior through inferior mediastinum. An about 2cm rupture site was confirmed on the left side of the lower thoracic esophagus and closed by suture and filling with pediculate omentum. The presence of a tumorous lesion located mainly in the body of the stomach and lymph node enlargement were also diagnosed before surgery, for which gastric and intestinal fistulae were inserted to prepare for the second-stage surgery. The patient was admitted to an ICU after surgery. ARDS and MRSA-induced pneumonia and enteritis concomitantly developed but remitted. Curative surgery for gastric cancer was performed at 40 POD. Spontaneous rupture of the esophagus is relatively rare and that complicated by gastric caner is very rare, with only six cases being reported in Japan. Herein, we report the case. Keywords: spontaneous rupture of the esophagus, gastric cancer, prediagnoisis
Background Spontaneous rupture of the esophagus is rare, and the life-saving rate is still low. We encountered a very rare case in which rupture occurred due to concomitant gastric cancer. Only 6 cases including this patient have been reported in Japan, and this is the first case report in English. The disease could be preoperatively diagnosed, and the patient could be saved despite the condition being very serious. Herein, we report the case. Case presentation The patient was a 71-year-old male with a chief complaint of abdominal pain. There was no particular past * Correspondence: [email protected] 1 Department of Surgery, 4-6-1 Noishiki, Gifu City 500-8717, Japan Full list of author information is available at the end of the article
medical history. The patient suddenly developed abdominal pain and vomiting on drinking soda after a meal, and visited a physician. Cervical subcutaneous and mediastinal emphysemas were observed on CT, and the patient was transferred to the emergency medical center of our hospital on the same day. On admission, the height was 168 cm; body weight, 55 kg; BP, 154/76 mmHg; HR,
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