Saito Shin, Hosoya Yoshinori, Kurashina Kentaro, Matsumoto Shiro, Kanamaru Rihito, Ui Takashi, Haruta Hidenori, Kitayama Joji, Lefor Alan K, Sata Naohiro
Department of Surgery, Jichi Medical University, Tochigi, Japan.
Int J Surg Case Rep. 2016;19:51-4. doi: 10.1016/j.ijscr.2015.12.016. Epub 2015 Dec 17.
Spontaneous esophageal perforation, or Boerhaave's syndrome, is a life-threating condition which usually requires emergent surgery. An upside down stomach is defined as a gastric volvulus in a huge supradiaphragmatic sac. In general, this condition can result in ischemia and perforation of the stomach. This is the first report of a patient with Boerhaave's syndrome and an upside down stomach.
A 79-year-old woman presented with sudden epigastric pain following hematemesis. Evaluation of the patient showed both an esophageal perforation and an upside down stomach. Surgical drainage and irrigation of the mediastinum and pleural cavities were undertaken emergently. Due to the concurrent gastric volvulus, a gastrostomy was placed to fix and decompress the stomach. The patient had an uneventful hospital course and was discharged.
Boerhaave's syndrome is a rare but severe complication caused by excessive vomiting, due to a sudden elevation in intraluminal esophageal pressure resulting in esophageal perforation. Acute gastric volvulus can result in ischemia and perforation of the stomach, but has not previously been reported with esophageal perforation. The most likely mechanism associating an upside down stomach with Boerhaave's syndrome is acute gastric outlet obstruction resulting in vomiting, and subsequent esophageal perforation. Perforation of the esophagus as well as perforation of the stomach must be considered in patients with an upside down stomach although both upside down stomach and Boerhaave's syndrome are rare clinical entities.
自发性食管穿孔，即博赫哈夫综合征，是一种危及生命的疾病，通常需要紧急手术。倒位胃被定义为巨大膈上囊内的胃扭转。一般来说，这种情况可导致胃缺血和穿孔。这是首例关于一名患有博赫哈夫综合征和倒位胃患者的报告。
一名79岁女性在呕血后出现突发上腹部疼痛。对该患者的评估显示存在食管穿孔和倒位胃。紧急进行了纵隔和胸腔的手术引流及冲洗。由于并发胃扭转，放置了胃造口术以固定和减压胃部。患者住院过程顺利并出院。
博赫哈夫综合征是一种由过度呕吐引起的罕见但严重的并发症，由于食管腔内压力突然升高导致食管穿孔。急性胃扭转可导致胃缺血和穿孔，但此前尚未有与食管穿孔相关的报道。倒位胃与博赫哈夫综合征相关的最可能机制是急性胃出口梗阻导致呕吐，继而引起食管穿孔。对于倒位胃患者，尽管倒位胃和博赫哈夫综合征都是罕见的临床病症，但必须考虑食管穿孔以及胃穿孔的情况。
