Aga Zeenia, Avelino Jackie, Darling Gail E, Leung Jo Jo
Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8.
Department of Emergency Medicine, University Health Network, Toronto, ON, Canada M5G 2C4.
Case Rep Emerg Med. 2016;2016:5971656. doi: 10.1155/2016/5971656. Epub 2016 Feb 2.
A 25-year-old previously healthy man presented to our Emergency Department with shortness of breath and epigastric pain after swallowing a boneless chicken nugget one hour prior to presentation. Physical examination revealed epigastric rigidity and tenderness. Serology was normal except for mildly elevated bilirubin and amylase. Computed tomography (CT) scan of the chest revealed a distal esophageal rupture with accompanying pneumomediastinum and left-sided pleural effusion. Treatment was initiated with administration of intravenous fluids and broad-spectrum antibiotics. Subsequently, an esophageal stent was inserted endoscopically in addition to VATS (Video-Assisted Thoracoscopic Surgery) drainage of the left-sided pleural space. This case illustrates an unusual presentation of Boerhaave's syndrome: a rare and life-threatening form of noniatrogenic esophageal rupture most often preceded by forceful vomiting. Our case demonstrates that physicians should maintain an index of suspicion for spontaneous esophageal rupture in patients presenting with shortness of breath and epigastric pain even in the absence of preceding vomiting, cough, or seizure. Additionally, ingestion of boneless, shell-less foods may be sufficient to cause rupture in individuals without underlying esophageal pathology. CT scan of the thorax and upper abdomen should be performed in these patients to rule out this rare and life-threatening diagnosis.
一名25岁既往健康的男性在就诊前1小时吞食无骨鸡块后，因呼吸急促和上腹部疼痛被送至我院急诊科。体格检查发现上腹部僵硬和压痛。血清学检查除胆红素和淀粉酶轻度升高外均正常。胸部计算机断层扫描（CT）显示食管远端破裂，伴有纵隔气肿和左侧胸腔积液。开始给予静脉输液和广谱抗生素治疗。随后，除了对左侧胸腔进行电视辅助胸腔镜手术（VATS）引流外，还通过内镜插入了食管支架。该病例说明了Boerhaave综合征的一种不寻常表现：一种罕见且危及生命的非医源性食管破裂形式，最常见于强力呕吐之后。我们的病例表明，即使在没有先前呕吐、咳嗽或癫痫发作的情况下，医生对于出现呼吸急促和上腹部疼痛的患者也应保持对自发性食管破裂的怀疑指数。此外，对于没有潜在食管病变的个体，摄入无骨、无壳食物可能足以导致破裂。对于这些患者应进行胸部和上腹部CT扫描，以排除这种罕见且危及生命的诊断。
