Spontaneous esophageal perforation concomitant with acute coronary syndrome

A 58-year-old man was admitted to our emergency room with hematemesis and strong epigastralgic pain. He had previously undergone percutaneous coronary intervention (PCI) for acute myocardial infarction, and ST elevation of V1-V5 on electrocardiogram upon arrival suspected acute coronary syndrome (ACS). Chest and abdominal CT scan revealed free air in the mediastinum and pyothorax in the left thoracic cavity. He was given a diagnosis of ACS accompanied by spontaneous esophageal perforation. PCI for ACS preceded the treatment for esophageal perforation. Thoracotomy for esophageal perforation was performed immediately after PCI. Esophageal rupture with a 5-cm longitudinal mucosal laceration in the left lower thoracic esophagus was closed by double layer anastomosis with continuous suture of the mucosa layer and interrupted suture of the muscle layer. The anastomosis was covered by a diaphragmatic patch. ACS and esophageal perforation are both life-threatening diseases in which the patient experiences symptoms of chest pain. This is a very rare case having two differential diseases concomitantly. Esophageal perforation may be followed by vomiting caused by ACS. Early diagnosis and appropriate treatment strategies according to the severity of the diseases are thought to be important in achieving satisfactory results.