胸腔鏡下ドレナージにて治療した特発性食道破裂の1例

Spontaneous esophageal rupture treated by thoracoscopic drainage : a case report

◆要旨：胸腔鏡下ドレナージにて治療した特発性食道破裂の1例を経験した．症例は54歳，男性．嘔吐をきっかけに左上腹部痛から左胸部痛があり，当院に救急受診された．胸部単純CT，食道造影と臨床経過より特発性食道破裂と診断した．造影剤の胸腔内への流出がほとんど認められなかったことと，食道の破綻部が小さかったため，胸腔鏡下手術でデブリードメントとドレナージを施行し，破綻部の縫合は施行しなかった．術後は良好な経過で術後第20病日に退院となった．特発性食道破裂でも破綻部が小さいものは，低侵襲である胸腔鏡下手術で治癒できる可能性があると思われた．

　We report a patient with spontaneous esophageal rupture that was treated by thoracoscopic drainage. A 54 years old man was admitted to our hospital because of vomiting followed by left upper abdominal pain and left chest pain after vomiting. Spontaneous esophageal rupture was diagnosed by chest plain CT, esophagography and clinical course. Debridement and drainage were performed by thoracoscopic surgery without suturing the perforation site because contrast medium didn't flow out into the thoracic cavity and perforation site of the esophagus was small. The patient was discharged on the 20 th post operative day with good post operative course. Thoracoscopic surgery is effective for spontaneous esophageal rupture when the perforation site is small.