A Case of Spontaneous Esophageal Rupture with Concurrent Hiatal Hernia

Spontaneous esophageal rupture is a disorder in which all the layers of the esophageal wall rupture due to a rapid increase in intra-esophageal pressure ; this event is fatal when it results in mediastinitis or empyema or when diagnosis and treatment are delayed. We report a case of spontaneous esophageal rupture with a concomitant hiatal hernia. The patient was a 67-year-old woman. After postprandial bloody vomiting, she experienced the onset of thoracodorsal pain and was transported to our hospital. Contrast enhanced CT showed findings raising suspicion of esophageal perforation along with a mixed type esophageal hiatal hernia. Most spontaneous esophageal rupture cases have perforations from the lower thoracic esophagus to the mediastinum and thoracic cavity and require thoracotomy. In this patient, no perforation occurred in the mediastinum or thoracic cavity ; a perforation did, however, occur locally in the intraperi-toneal direction in the hernia sac. As it was the opening of an esophageal hiatus resulting from esophageal hiatal hernia, the visual field in the mediastinum was good even with the transabdominal approach, allowing treatment with laparotomy. As the sites and forms of hiatus may be different in patients with spontaneous esophageal rupture where anatomical changes such as esophageal hiatal hernia are present, it is important to select appropriate surgical procedures including the optimal method of approach.