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  • Title: Pneumomediastinum following a prolonged second stage of labor - an emphasis on early diagnosis and conservative management: a case report.
    Author: Whelan S, Kelly M.
    Journal: J Med Case Rep; 2017 Nov 06; 11(1):313. PubMed ID: 29110705.
    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.
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