Inoue K, Makita T, Arai Y, Fukushima M, Kashima T, Takaba T
Department of Surgery, Showa University, School of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Oct;39(10):1923-6.
Spontaneous rupture of the esophagus is rare. It's initial symptoms are so varied that we often have a hard time for making early diagnosis of esophageal rupture. In this case, emergency surgery was performed immediately after early diagnosis by chest CT. When the left thoracotomy was done, the upper portion of the stomach protruded with it's mucous membrane was reflected outward into the thoracic cavity above the diaphragm. When the reflected stomach was drawn back into the abdominal cavity for replacement, a ruptured wound of about 5 cm was observed on the left wall of the esophagus above the diaphragm. The stomach was seen protruded from this ruptured wound of the esophagus, with the mucous membrane reflected outward. No pathological abnormalities of esophagus itself was detected even after through investigation to search the cause for this clinically manifested weakness of the esophageal wall which eventually ruptured causing protrusion of the upper portion of the stomach into the thoracic cavity. The mechanism of this gastric protrusion is difficult to define. The most informative diagnostic investigation was the chest CT.
食管自发性破裂较为罕见。其初始症状多种多样，以至于我们常常难以早期诊断食管破裂。在该病例中，通过胸部CT早期诊断后立即进行了急诊手术。行左胸切开术时，胃的上部连同其黏膜向外翻入膈肌上方的胸腔。当将翻出的胃拉回腹腔复位时，在膈肌上方食管左壁观察到一个约5厘米的破裂伤口。可见胃从食管的这个破裂伤口处突出，黏膜向外翻。即使经过全面检查以寻找导致食管壁出现这种临床表现为薄弱并最终破裂致使胃上部突入胸腔的原因，也未发现食管本身存在病理异常。这种胃突出的机制难以明确。最具诊断价值的检查是胸部CT。
