Endoscopic repair of spontaneous esophageal rupture during gastroscopy

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RATIONALE: Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy. PATIENT CONCERNS: A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. During the gastroscopy, he vomited severely, which was followed by severe left chest pain radiating into the back and upper abdomen. The diagnosis was made by computed tomography (CT) scan without delay. Enhanced CT showed extensive mediastinal emphysema, a small amount of left pleural effusion, and a 6 cm tear was confirmed in the lower esophagus posteriorly. DIAGNOSES: The patient was diagnosed with an intrathoracic rupture type of spontaneous esophageal rupture. INTERVENTIONS: The patient received endoscopic suturing techniques under endotracheal intubation, titanium clip clamping, and over the scope clip (OTSC) sealing. OUTCOMES: The procedure was smooth and the patient recovered well after operation. LESSONS: During gastroscopy, the risk of esophageal rupture should be considered due to sudden pain caused by severe nausea and vomiting. Esophageal rupture can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.

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