Pneumomediastinum following a prolonged second stage of labor - an emphasis on early diagnosis and conservative management: a case report

J Med Case Rep. 2017 Nov 6;11(1):313. doi: 10.1186/s13256-017-1482-1.

Abstract

Background: Esophageal rupture is an extremely rare condition to occur to a pregnant or postnatal woman. Esophageal ruptures have been previously described in the literature; however, they are most common in the setting of hyperemesis gravidarum.

Case presentation: This case report describes a 27-year-old white woman who began complaining of central chest pain and shortness of breath 3 hours after a normal vaginal delivery, with no history of vomiting antenatally or intrapartum. A chest X-ray and computed tomography pulmonary angiogram confirmed surgical emphysema and pneumomediastinum, and a diagnosis of esophageal rupture was made based on these findings. She was stable and conservative management was initiated; she improved over 4 days. Resolution of surgical emphysema was demonstrated on serial chest X-rays without requiring contrast swallow or surgical intervention.

Conclusions: This case exemplifies the importance of a timely diagnosis of esophageal rupture in ensuring a positive outcome for the patient. Delay in diagnosis can lead to an increase in morbidity and mortality.

Keywords: Esophageal rupture; Intrapartum; Pneumomediastinum; Pregnancy; Subcutaneous emphysema.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Angiography
  • Chest Pain / diagnosis*
  • Chest Pain / diagnostic imaging
  • Chest Pain / etiology
  • Conservative Treatment
  • Early Diagnosis
  • Esophageal Perforation / diagnosis*
  • Esophageal Perforation / diagnostic imaging
  • Esophageal Perforation / physiopathology
  • Esophageal Perforation / therapy*
  • Female
  • Humans
  • Labor, Obstetric*
  • Mediastinal Emphysema / diagnosis*
  • Mediastinal Emphysema / diagnostic imaging
  • Mediastinal Emphysema / etiology
  • Mediastinal Emphysema / therapy*
  • Postpartum Period*
  • Pregnancy
  • Radiography, Thoracic
  • Tomography, X-Ray Computed
  • Treatment Outcome