Post-
emetic spontaneous rupture of the esophagus (
Boerhaave's syndrome) is still a life-threatening condition, despite recent advances in thoracic surgery and
critical care medicine. Because a case report on
anesthetic management of this condition is rare, we report here successful management of a 46-yr-old man with spontaneous esophageal
rupture following forceful
vomiting. He suddenly developed severe
back pain and acute respiratory distress after
vomiting during dinner and was brought to our emergency department. Examination on admission revealed an increased respiratory rate of 20 min(-1) with SpO2 97% with a facemask (O2, 3 l x min(-1)), a pulse rate of 100 min(-1), and a blood pressure of 138/88 mmHg. Upper gastrointestinal endoscopy showed a
foreign body and CT examination revealed
subcutaneous emphysema. He was diagnosed as
spontaneous rupture of the esophagus. Emergency T-tube drainage was therefore scheduled. After semi-awake intubation with
midazolam,
general anesthesia was maintained with O2 (50%), N2O,
sevoflurane (2%), and
vecuronium infusion. A bronchial blocker was used for
one lung ventilation to facilitate thoraco-abdominal approach. A careful attention should be paid to tracheal intubation to avoid any increase in intra-abdominal pressure to prevent further spillage of gastric contents into the mediastinum through the perforation. A transmural tear in the anterior wall of the esophagus was found and the
foreign body (boiled meat) was removed. The patient recovered uneventfully and could be extubated on the first day in the ICU. It should be noted that successful management of this disease depends on accurate diagnosis and appropriate choice of treatments.