Spontaneous rupture of esophageal diverticulum

A case of spontaneous rupture of the esophageal diverticulum of the lower esophagus is presented. A 47-year-old man was referred to our emergency center with the chief complaint of chest pain which occurred suddenly at midnight without vomiting. Chest X-ray films and CT scan showed pleural effusion, pneumomediastinum and subcutaneous emphysema of the neck. Gastrografin study showed a perforation of the lower esophagus into the left thoracic cavity. Endoscopic examination revealed a diverticulum of the lower esophagus, a perforation at the top of this diverticulum and white exudate into diverticulum. We performed primary closure through thracotomy 43 hours after the onset of pain. After surgery, mediastinal abscess and pyothorax developed; therefore, we performed open chest drainage followed by esophagostomy. In addition, we performed esophagectomy and esophagogastrostomy through the anterior-thoracic wall route about 7 months after the first operation. His course was uneventful after the final operation. Perforation of the esophageal diverticulum has been reported in only 10 cases in Japan. Perforation of the esophagus without vomiting should be taken into consideration in esophageal diverticulum.