Ambrose Tim, Rajendran Natesan, Macfaul George
Department of Gastroenterology, Milton Keynes General Hospital.
Br J Hosp Med (Lond). 2011 Oct;72(10):592. doi: 10.12968/hmed.2011.72.10.592.
This article discusses an elderly woman presenting with haematemesis and chest pain who underwent urgent oesophago-gastroduodenoscopy. This revealed a large dissecting intramural oesophageal haematoma, initially mistaken for a varix. This is a rare cause of haematemesis and chest pain but has characteristic endoscopic findings. It is a benign condition that may be managed conservatively and both clinicians and endoscopists should be aware of its classical presentation. Misdiagnosis of the chest pain as cardiac ischaemia may have an adverse outcome if antiplatelet or anticoagulation therapy is commenced. Follow up endoscopy a week later showed complete resolution of the lesion leaving a linear mucosal defect.
本文讨论了一位出现呕血和胸痛症状的老年女性，她接受了紧急食管胃十二指肠镜检查。检查发现一个巨大的壁内食管夹层血肿，最初被误诊为静脉曲张。这是呕血和胸痛的罕见原因，但具有特征性的内镜表现。它是一种良性疾病，可采用保守治疗，临床医生和内镜医生都应了解其典型表现。如果开始使用抗血小板或抗凝治疗，将胸痛误诊为心脏缺血可能会产生不良后果。一周后的随访内镜检查显示病变完全消退，仅留下一条线性黏膜缺损。
