This report describes a case of spontaneous
esophageal perforation that was considered to be etiologically related to a
duodenal ulcer with
pyloric stenosis. The patient was a 54-year-old Japanese man who presented following the sudden onset of severe
abdominal pain and
dyspnea after an episode of
vomiting. He had a history of
duodenal ulcer. Computed tomography revealed an extremely dilated stomach containing abundant food residue, intraabdominal effusion, bilateral
pleural effusion, and
mediastinal emphysema, findings that strongly suggested
esophageal perforation. Esophagoscopy confirmed perforation of the lower esophagus.
Laparotomy revealed marked contamination, including food residue in the abdominal cavity, and a severely dilated stomach attributed to
pyloric stenosis caused by a
duodenal ulcer. A 2-cm longitudinal perforation was found on the right side of the lower esophagus. Because the patient's general condition was too poor to tolerate a one-stage operation (primary closure of the perforation,
gastrectomy, and reconstruction), we initially performed
decompression gastrostomy and control of the esophageal leakage with T-tube placement. Following the T-tube was removed 1 month later, distal
gastrectomy and reconstruction of the
gastrojejunostomy (
Billroth II method) could be safely performed.