A CASE OF SPONTANEOUS RUPTURE OF THE ESOPHAGUS, IN WHICH A FIBRIN PASTE PREPARATION WAS EFFECTIVE FOR POSTOPERATIVE REFRACTORY FISTULA

A 70-year-old woman underwent emergency operation 7 hours after the onset of spontaneous rupture of the esophagus which was diagnosed by esophagofluoroscopy. The ruptured site was found in the left anterior wall of the esophagus which was located right above the diaphragm. The site was bistratally sutured by one-step method and two intrathoracic drainages were made. After surgery insufficiency of the suture and empyema developed, in which sustained washing and sustained hypotonic aspiration leaded to a fistulization of the empyema with a slight decrease in size. However, the patient also had a syringeal bronchial fistula, and the contamination with saliva as well as digestive liquid made the therapy difficult. After careful observation of this refractory fistula by endoscopy, it was filled with a fibrin-paste preparation while the contamination was prevented by two balloons. In a relatively short period, the fistula could be successfully closed.