Sakatoku Yayoi, Fukaya Masahide, Miyata Kazushi, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Surg Case Rep. 2017 Dec;3(1):4. doi: 10.1186/s40792-016-0277-8. Epub 2017 Jan 4.
Acute esophageal necrosis (AEN) is a rare clinical disorder. Esophageal stenosis or obstruction is one of severe complications, but there are a few reports about surgical treatments. In such a situation, it still remains controversial which to choose, esophagectomy or bypass operation.
A 61-year-old woman was admitted to the local hospital for septic shock with diabetic ketoacidosis due to necrotizing fasciitis of the right thigh. Three days later, she had hematemesis, and gastrointestinal endoscopy revealed black mucosal coloration throughout the entire esophagus. She was diagnosed as having AEN. Her general condition improved after intensive care, debridement, and treatment with antibiotics and a proton pump inhibitor; the esophageal mucosal color recovered. However, an esophageal stricture developed after 1 month, and the patient underwent gastrostomy to remove an esophageal obstruction after 3 months. She was referred to our hospital for surgical treatment 1 year and 4 months after the occurrence of AEN because of her strong desire for oral intake. Her medical condition was poor, and she could not walk due to generalized muscle weakness. After rehabilitation for 8 months, we performed an esophageal bypass using a gastric conduit via the percutaneous route rather than esophagectomy because of her multiple severe comorbidities including walking difficulty, chronic hepatitis C, cerebrovascular disease, and chronic renal failure. Minor leakage of the esophagogastrostomy occurred and was resolved with conservative treatment. The patient began oral intake on postoperative day 34 and was discharged on day 52.
Esophageal obstruction after AEN was successfully treated by esophageal bypass using a gastric conduit in a high-risk patient. Because the majority of patients with AEN have multiple severe comorbidities, assessing the medical condition of the patient adequately is important prior to choosing either an esophagectomy or bypass surgery.
急性食管坏死（AEN）是一种罕见的临床疾病。食管狭窄或梗阻是其严重并发症之一，但关于手术治疗的报道较少。在这种情况下，选择食管切除术还是旁路手术仍存在争议。
一名61岁女性因右大腿坏死性筋膜炎导致感染性休克合并糖尿病酮症酸中毒入住当地医院。三天后，她出现呕血，胃肠内镜检查显示整个食管黏膜呈黑色。她被诊断为AEN。经过重症监护、清创以及使用抗生素和质子泵抑制剂治疗后，她的一般状况有所改善，食管黏膜颜色恢复。然而，1个月后出现食管狭窄，3个月后患者接受胃造瘘术以解除食管梗阻。由于她强烈希望经口进食，在AEN发生1年4个月后被转诊至我院接受手术治疗。她的身体状况较差，因全身肌肉无力无法行走。经过8个月的康复治疗后，由于她存在包括行走困难、慢性丙型肝炎、脑血管疾病和慢性肾衰竭在内的多种严重合并症，我们通过经皮途径使用胃管道进行食管旁路手术而非食管切除术。食管胃吻合口出现轻微渗漏，经保守治疗后得以解决。患者术后第34天开始经口进食，第52天出院。
对于一名高危患者，通过使用胃管道进行食管旁路手术成功治疗了AEN后的食管梗阻。由于大多数AEN患者有多种严重合并症，在选择食管切除术或旁路手术之前充分评估患者的身体状况很重要。
