A Case of Esophageal Cancer Associated with Postoperative Spontaneous Esophageal Rupture Twenty Years Earlier

Cases of spontaneous rupture of the esophagus are relatively rare and those of esophageal cancer associated metachronously with spontaneous rupture of the esophagus extremely rare. We report a case of advanced esophageal cancer occurring at the site of an esophageal rupture 20 years postoperatively. A 60-year-old man diagnosed with spontaneous rupture of the esophagus and operated on 20 years earlier had an approximately 4cm vertical perforation in the left wall of the lower esophagus. The ruptured esophageal wall was directly closed layer to layer, but anastomotic leakage kept the patient hospitalized for 2 months. Twenty years after surgery, he was diagnosed with esophageal cancer fistulized to the left bronchus (B10), necessitating transthoracic esophagectomy by right thoracotomy and resection of the esophagobronchial fistula. The resected specimen was diagnosed histologically as well-differentiated squamous cell carcinoma but without cancer cells in regional lymph nodes or the fistula. Chronic continuous inflammation of the rupture site with leakage apparently induced malignant change in the esophageal mucosa. Spontaneous rupture of the esophagus must thus be considered a risk factor in esophageal cancer, necessitating long, meticulous postoperative follow-up after surgery for spontaneous rupture of the esophagus.