Successful late management of spontaneous esophageal rupture using T-tube mediastinoabdominal drainage

Background: Spontaneous esophageal rupture is extremely rare, and early sym ptoms of the disease are similar to those of emergency diseases of the ches t and abdomen. The diagnosis and treatments are often delayed, resulting in an unfavorable outcome in some cases. Methods: We performed improved T-tube drainage for spontaneous esophageal. rupture in 5 patients between 1995 and 1999. Our improved method was a modi fied procedure of the reported method of Abbott et al, as follows: a T-tube was inserted into the esophagus. A separate stab incision was made in the abdominal wall, and the long limb of the T-tube was brought out through thi s incision ensuring that the course of the T-tube intra-abdominally was sho rt and straight, with some slack to allow for postoperative abdominal diste nsion. An advantage of this method was that it facilitated healing of the f istula after removal of the T-tube. Results: All patients were treated with a satisfactory outcome. Conclusion: This improved T-tube drainage was technically very easy and saf e method for spontaneous esophageal rupture in severe cases. (C) 2001 Excer pta Medica, Inc. All rights reserved.