Wise Matt Peter, Salmon Jonathan B, Maynard Nick D
University Hospital of Wales, Adult Critical Care, Heath Park, Cardiff CF14 4XW, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0375. Epub 2009 Feb 20.
A 79-year-old man presented to the Emergency Department with abdominal pain 1 day after an elective total knee replacement. The patient was confused and drowsy, with a high fever, hypotension and uncontrolled atrial fibrillation. He subsequently developed respiratory failure, requiring admission to intensive care. It was then noted that a large pleural effusion had developed between two chest radiographs performed only 4 h apart. A pigtail catheter inserted into the pleural space revealed a transudate of pH 7.0 with an amylase of 17 220 U (serum amylase 54 U), and thus a diagnosis of spontaneous oesophageal rupture or Boerhaave syndrome was made. Despite drainage of the pleural space, the patient developed shock and multiorgan failure requiring mechanical ventilation, renal replacement therapy and cardiovascular support. The oesophageal leak was treated conservatively with intercostal tube drainage; the patient made a full recovery and was discharged from hospital 75 days later.
一名79岁男性在择期全膝关节置换术后1天因腹痛就诊于急诊科。患者神志不清、嗜睡，伴有高热、低血压及控制不佳的心房颤动。随后他出现呼吸衰竭，需要入住重症监护病房。此时发现，在仅间隔4小时拍摄的两张胸部X光片之间出现了大量胸腔积液。插入胸腔的猪尾导管引出的胸腔积液pH值为7.0，淀粉酶含量为17220 U（血清淀粉酶为54 U），因此诊断为自发性食管破裂或博赫哈夫综合征。尽管进行了胸腔引流，但患者仍出现休克和多器官功能衰竭，需要机械通气、肾脏替代治疗及心血管支持。食管漏采用肋间置管引流进行保守治疗；患者完全康复，75天后出院。
