title: Conservative treatment of esophageal perforation related to a peptic ulcer with pyloric stenosis.
abstract: We report a case of esophageal perforation (Boerhaave syndrome) caused by vomiting related to a duodenal ulcer with pyloric stenosis. A 45-year-old male presented with left chest pain and dyspnea after forceful vomiting. Chest radiography and computed tomography (CT) revealed a massive left pleural effusion and left tension pneumothorax. Abdominal CT revealed pyloric stenosis with a remarkably dilated stomach. Tube thoracostomy and nasogastric suction were immediately performed and we selected conservative treatment based on the following factors-a stable general condition without sepsis, early diagnosis, and good drainage. Esophagogastroduodenoscopy on hospital day 9 demonstrated a healing ulcer in the lower esophagus and pyloric stenosis. We performed distal gastrectomy as elective surgery for pyloric stenosis due to a duodenal ulcer on hospital day 30. In summary, an esophageal perforation with contamination spreading to the thoracic cavity was successfully treated with conservative treatment.
authors.affiliation: Division of Digestive Surgery, Tachikawa Medical Center, Niigata, Japan, tanakaryo1001@med.niigata-u.ac.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Tanaka
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Kosugi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hirukawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hanyu
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
mesh_terms: D004381:Duodenal Ulcer / Q000150:complications*; D004939:Esophageal Perforation / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged; D011707:Pyloric Stenosis / Q000150:complications*; D012074:Remission Induction; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation