Undiagnosed spontaneous oesophageal rupture presenting as right hydropneumothorax

  • Vivek Agrawal
  • Deepanshu Aggarwal
Case Report


Spontaneous oesophageal rupture has been a known ailment with a high morbidity and mortality. Various factors contribute to its predisposition such as preexisting oesophageal diseases, increased intraluminal pressure, neurogenic causes, and iatrogenic-commonest being instrumentation. We present the case of a 26-year-old male with features of right hydropneumothorax for which an intercostal chest drain (ICD) was inserted that yielded turbid fluid with suspicion of it being gastric contents. With a diagnosis of diaphragmatic hernia and gut/bowel injury caused due to intercostal drain, the patient underwent emergency exploratory laparotomy. No abnormality was detected and possibility of oesophageal injury/rupture was contemplated though ruled out on investigations. The patient improved with medical treatment of empyema and discharged. The patient was lost to follow-up until after a year the patient reported to surgery OPD with complaints of dysphagia. A barium swallow revealed thoracic oesophageal benign stricture thus confirming our suspicion of spontaneous oesophageal rupture that had occurred a year ago. Knowledge about atypical presentations of oesophageal rupture is important so as to be more aware of this possibility.


Boerhaave syndrome Oesophageal perforation Oesophageal stricture 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from the patient included in the study.


  1. 1.
    Pillinger T, Rogers A, Barnes S. Oesophageal rupture: A tough diagnosis to swallow. BMJ Case Rep. 2013;
  2. 2.
    Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77:1475–83.Google Scholar
  3. 3.
    Sawyers JL, Lane CE, Foster JH, Daniel RA. Esophageal perforation: an increasing challenge. Ann Thorac Surg. 1975;19:233–8.Google Scholar
  4. 4.
    Rassameehiran S, Klomjit S, Nugent K. Right-sided hydropneumothorax as a presenting symptom of Boerhaave’s syndrome (spontaneous esophageal rupture). Proc (Bayl Univ Med Cent). 2015;28:344–6.Google Scholar
  5. 5.
    Rokszin R, Simonka Z, Paszt A, Szepes A, Kucsa K, Lazar G. Successful endoscopic clipping in the early treatment of spontaneous esophageal perforation. Surg Laparosc Endosc Percutan Tech. 2011;21:e311–2.Google Scholar
  6. 6.
    Cascio A, Barone M, Micali V, et al. On a fatal case of Candida krusei pleural empyema in a pregnant woman with spontaneous esophagus perforation. Mycopathologia. 2010;169:451–5.Google Scholar
  7. 7.
    Ieta K, Oki A, Teshigahara K, et al. Recurrent spontaneous esophageal rupture. Clin J Gastroenterol. 2013;6:33–7.Google Scholar
  8. 8.
    Bhatia P, Fortin D, Inculet RI, Malthaner RA. Current concepts in the management of esophageal perforations: a twenty-seven year Canadian experience. Ann Thorac Surg. 2011;92:209–15.Google Scholar
  9. 9.
    Jha AK, Agrawal V, Khurshiwal K, Chauhan A. Gastropleural fistula in a case of tubercular empyema thoracis. Indian J Thorac Cardiovasc Surg. 2018;34:53–5.Google Scholar
  10. 10.
    Agrawal V, Jain M, Mohanty D, Garg PK. Oesophageal perforation: disastrous consequence of accidental barotrauma. Indian J Thorac Cardiovasc Surg. 2014;30:303–5.Google Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity College of Medical Sciences, DelhiNew DelhiIndia
  2. 2.Department of SurgeryUniversity College of Medical Sciences, DelhiDelhiIndia

Personalised recommendations