Spontaneous rupture of the esophagus after coronary artery bypass.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare but the most lethal perforation of the gastro-intestinal tract. A 62-year old male was successfully treated for this condition developing on the second post-operative day after coronary artery bypass. Two hours after extubation respiratory insufficiency and circulatory collapse necessitated reintubation and energetic resuscitation with prompt drainage of a massive pleural effusion. Left thoracotomy on post-operative day 17 confirmed the diagnosis and the esophagus was excluded by cervical esophagostomy and duodenostomy. After a six week recovery, reconstruction was achieved by total esophagectomy through a right thoracic incision and gastric bypass with cervical gastro-esophageal anastomosis. The patient left the hospital in good condition 112 days after the initial operation.