1．特発性・医原性食道破裂

Idiopathic and Iatrogenic Esophageal Rupture

食道に関連した緊急手術の適応となる疾患の中に，全層性の損傷である食道破裂がある．食道破裂は比較的まれな疾患であるが，対応が遅れると縦隔炎が重篤となり，生命の危機を及ぼす状態に発展してしまう．できるだけすみやかな診断と治療の開始が必要である．

One of the most common indications for emergency surgery is full-layer rupture of the esophagus. Iatrogenic injury to the esophagus is the most frequent cause of esophageal rupture, followed by spontaneous rupture. If the patient is not treated promptly, mediastinitis can develop into a serious and life-threatening condition. Diagnosis and treatment must be initiated as soon as possible. Spontaneous esophageal rupture often requires emergency surgical intervention. Various surgical techniques for esophageal rupture have been reported, including transabdominal or transthoracic, open or thoracoscopic surgery, drain placement, and surgical position. There have been reports of thoracoscopic primary closure of esophageal tear and thoracic drainage in the prone or lateral decubitus position. On the other hand, iatrogenic esophageal rupture is often treated conservatively, those patients require fasting, administration of antibiotics and proton pump inhibitors, suctioning and decompression using nasogastric tube, and chest drainage if necessary. In addition, close follow-up should be maintained so that the opportunity for surgery is not missed when necessary. Although esophageal rupture is relatively rare and is not an everyday occurrence, it is an urgent condition that requires prompt diagnosis and treatment, so it is necessary to have prior knowledge and to respond promptly.