Cullen S N, McIntyre A S
Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK.
Eur J Gastroenterol Hepatol. 2000 Oct;12(10):1151-62. doi: 10.1097/00042737-200012100-00014.
Dissecting intramural haematoma of the oesophagus is an under-recognized cause of sudden onset chest pain. Diagnosis is aided by the common co-existence of haematemesis, odynophagia, and dysphagia. Oesophagoscopy, barium swallow and cross-sectional radiology are all appropriate modalities of investigation. The latter is useful in excluding aortic dissection from the differential diagnosis. The condition usually follows a benign course with spontaneous healing requiring supportive treatment only. A systematic analysis of all the cases of dissecting intramural haematoma of the oesophagus (DIHO) reported in the worldwide literature reveals that this is essentially a benign condition. Eighty per cent of patients have at least two of the three typical presenting features of chest pain, haematemesis and dysphagia or odynophagia. Forty-nine per cent of cases are associated with sudden pressure changes within the oesophagus (e.g. due to swallowing) or secondary to direct trauma to the oesophagus. A further group appears to arise spontaneously and may be associated with underlying abnormal pressure changes within the oesophagus or a bleeding tendency. Awareness of the condition prevents the pain being mistakenly attributed to a cardiac cause. With conservative management the symptoms usually resolve within 2 weeks of presentation. The only mortality associated with DIHO is due to operative intervention or where there is another underlying life-threatening condition.
食管壁内血肿是突发胸痛的一种未被充分认识的病因。呕血、吞咽痛和吞咽困难等常见并存症状有助于诊断。食管镜检查、吞钡造影和横断面影像学检查都是合适的检查方式。后者有助于在鉴别诊断中排除主动脉夹层。该病通常呈良性病程，仅需支持治疗即可自发愈合。对全球文献报道的所有食管壁内血肿（DIHO）病例进行系统分析发现，这本质上是一种良性疾病。80%的患者至少具有胸痛、呕血以及吞咽困难或吞咽痛这三种典型表现中的两种。49%的病例与食管内突然的压力变化（如因吞咽）或食管直接创伤继发有关。另有一组病例似乎是自发出现的，可能与食管内潜在的异常压力变化或出血倾向有关。认识到这种疾病可防止将疼痛错误地归因于心脏原因。采用保守治疗，症状通常在出现后2周内缓解。与DIHO相关的唯一死亡原因是手术干预或存在其他潜在的危及生命的情况。
