Fig. 3

Surgical findings. a Via the thoracotomy incision, a rupture site is seen on the wall of the lower esophagus above the diaphragm. b Via a laparotomy midline incision in the upper abdomen, a 4-cm-long rupture is seen on the left side of the lower esophagus, and the rupture extends to the gastroesophageal junction. c Via the left thoracotomy, the ruptured esophageal wall was primarily repaired by closure with two-layer suturing and covered by pedicled omentum which was elevated thorough the esophageal hiatus (black dotted line, pedicled omentum)