[Anesthetic management of a patient with post-emetic rupture of the esophagus induced by a foreign body].

Post-emetic spontaneous rupture of the esophagus (Boerhaave's syndrome) is still a life-threatening condition, despite recent advances in thoracic surgery and critical care medicine. Because a case report on anesthetic management of this condition is rare, we report here successful management of a 46-yr-old man with spontaneous esophageal rupture following forceful vomiting. He suddenly developed severe back pain and acute respiratory distress after vomiting during dinner and was brought to our emergency department. Examination on admission revealed an increased respiratory rate of 20 min(-1) with SpO2 97% with a facemask (O2, 3 l x min(-1)), a pulse rate of 100 min(-1), and a blood pressure of 138/88 mmHg. Upper gastrointestinal endoscopy showed a foreign body and CT examination revealed subcutaneous emphysema. He was diagnosed as spontaneous rupture of the esophagus. Emergency T-tube drainage was therefore scheduled. After semi-awake intubation with midazolam, general anesthesia was maintained with O2 (50%), N2O, sevoflurane (2%), and vecuronium infusion. A bronchial blocker was used for one lung ventilation to facilitate thoraco-abdominal approach. A careful attention should be paid to tracheal intubation to avoid any increase in intra-abdominal pressure to prevent further spillage of gastric contents into the mediastinum through the perforation. A transmural tear in the anterior wall of the esophagus was found and the foreign body (boiled meat) was removed. The patient recovered uneventfully and could be extubated on the first day in the ICU. It should be noted that successful management of this disease depends on accurate diagnosis and appropriate choice of treatments.