Abstract：
A 74-year-old male patient was referred with signs of sepsis 5 days after having been diagnosed with a rib fracture following a fall out of bed. Novel hypodensities were visible on thoracic X‑rays and laboratory tests revealed elevated inflammatory parameters. Subsequently performed thoracic computed tomography (CT) scan showed burst fracture of the 3rd thoracic vertebra, posttraumatic esophageal rupture at the same level and mediastinitis. Furthermore, marked degenerative changes of the spinal column (diffuse idiopathic skeletal hyperostosis) were present. The patient underwent emergency thoracotomy and esophagectomy. Gastric pull-up with esophagogastrostomy was postponed for 3 days. After 14 days on the intensive care unit (ICU) and 12 days of i.v. antibiotics, the patient was transferred to the general ward and 7 weeks after trauma the patient was infection-free without difficulties in swallowing. Up to the latest follow-up 41 months following injury, several endoscopic dilations with a bougie due to constrictions at the anastomosis have been performed. Similar to previous cases in the literature, esophageal injury was diagnosed delayed, with the patient already having developed severe complications. This extremely seldom injury should be suspected in young patients following high-energy trauma, but also in older patients after low-energy trauma but known degenerative changes of the vertebral column.
摘要：
一名74岁的男性患者在下床后被诊断为肋骨骨折5天后被转诊为败血症的迹象。在胸部X射线上可以看到新的低密度，实验室测试显示炎症参数升高。随后进行的胸部计算机断层扫描（CT）扫描显示第三胸椎爆裂骨折，创伤后同一水平食管破裂和纵隔炎。此外，存在明显的脊柱退行性变化（弥漫性特发性骨骼肥大）。患者接受了紧急开胸手术和食管切除术。食管胃吻合术的胃牵拉术被推迟3天。在重症监护病房（ICU）和12天的静脉注射抗生素后，患者被转移到普通病房,创伤后7周,患者无感染,无吞咽困难.受伤后41个月的最新随访，由于吻合口的收缩，已经进行了几次内窥镜扩张。与文献中以前的案例类似，食管损伤被诊断为延迟，患者已经出现严重并发症。高能量创伤后的年轻患者应该怀疑这种极其罕见的伤害，而且在低能创伤但已知脊柱退行性改变的老年患者中也是如此。
