経食道裂孔的に腹腔鏡下縫合閉鎖を行った両側開胸手術既往のある食道破裂の1例

A case of spontaneous esophageal rupture treated with primary closure via the laparoscopic transhiatal approach in a patient who had previously undergone bilateral thoracic surgery

◆要旨：特発性食道破裂は早期に手術治療を要することが多い緊急性の高い疾患である．今回筆者らは，腹腔鏡による経食道裂孔的アプローチで治療した特発性食道破裂の1例を経験した．患者は41歳，男性．巨大肺囊胞に対し両側の開胸手術歴がある．食事中に生じた胸痛を主訴に受診し，胸部CTにて縦隔気腫，縦隔膿瘍の所見を認めた．消化管内視鏡検査を施行し胸部中部食道前壁に穿孔部を認め，特発性食道破裂と診断した．両側開胸手術後であったため，腹腔鏡で経裂孔的にドレナージおよび縫合閉鎖を行った．術後縫合不全を生じたが保存的に改善し，術後第44病日に退院した．特発性食道破裂に対する腹腔鏡下手術は有効な術式の1つであることが示唆された．

　Spontaneous esophageal rupture is a rare disorder mostly requiring emergency operation. We report a case of spontaneous esophageal rupture treated via the laparoscopic transhiatal approach. The patient was a 41-year-old man who had previously undergone bilateral thoracic surgery. He experienced acute chest pain during a meal, and was transported to our hospital. Chest CT scan demonstrated pneumomediastinum, pneumoderma, and a mediastinal abscess. Upper endoscopy revealed a laceration of the middle thoracic esophagus. We diagnosed spontaneous esophageal rupture, and an emergency operation was performed.　Because the patient had undergone previous thoracic surgery, we performed drainage and primary closure via the laparoscopic transhiatal approach. Anastomotic leakage was observed after the operation. However, the leakage improved with conservative treatment and he was discharged on the 44th postoperative day. It is suggested that laparoscopic surgery is an effective approach for treating spontaneous esophageal rupture.