Two Cases of Spontaneous Esophageal Rupture Successfully Treated by Transhiatal Thoracic Drainage under the Median Phrenotomy

We report 2 patients with spontaneous esophageal rupture with pyothorax and mediastinitis treated by transhiatal thoracic drainage under median phrenotomy. Case 1: A 77-year-old man underwent surgery for spontaneous esophageal rupture with pyothorax and mediastinitis 7 days after onset. During surgery, we found a large amount of pus and saburra in the mediastinal space, bilateral cavum thoracis, and a 5cm horizontal tear in the left wall of the lower esophagus, and extensive necrosis of the esophageal adventitia. We conducted transhiatal esophagectomy, cervical esophagostomy, gastrostomy, jejunostomy, and transhiatal drainage of the bilateral cavum thoracis and mediastinal space, and esophagus reconstruction by secondary gastric tube. Case 2: A 58-year-old man underwent surgery for spontaneous esophageal rupture with pyothorax and mediastinitis 1 day after onset. During surgery, we found a large amount of pus and saburra in the mediastinal space, right cavum thoracis, and a 6 cm horizontal tear in the right wall of the lower esophagus. After primary closure the esophageal rupture, we applied a pedicled omental flap over the suture site and instituted transhiatal drainage of the right cavum thoracis and mediastinal space. Esophagography indicated no leakage or stenosis, and oral intake was resumed 19 days postoperatively.