Kircheva Diana Y, Vigneswaran Wickii T
Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637-1470, United States.
Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637-1470, United States.
Int J Surg Case Rep. 2017;35:49-52. doi: 10.1016/j.ijscr.2017.03.038. Epub 2017 Apr 1.
Spontaneous esophageal rupture is rare, roughly 300 cases reported annually. Diagnosis is often delayed or missed. Overall mortality is about 20%. This feared high mortality rate has led to the misconception that primary esophageal repair should be avoided in late diagnosed patients. We report a successful primary repair of spontaneous esophageal rupture which was delayed for more than two weeks.
A 53 year-old male presented to our medical service after falsely having been treated for pneumonia at an outside hospital. He was subsequently diagnosed with spontaneous esophageal rupture and treated with over the scope clips followed by stenting. Persistent leak into mediastinum made surgical exploration necessary. At exploration a primary repair could be performed successfully.
Unsuccessful endoscopic management of esophageal perforation that was delayed for two weeks underwent primary surgical repair without complications.
Primary closure of late diagnosed spontaneous esophageal rupture can be successful, even when it is complicated by a prolonged delay in treatment and failed endoscopic procedures. We conclude that primary surgical repair should be attempted in patients with spontaneous esophageal rupture if tissues are viable.
自发性食管破裂较为罕见，每年报告约300例。诊断往往延迟或漏诊。总体死亡率约为20%。这种令人担忧的高死亡率导致了一种误解，即对于晚期诊断的患者应避免进行一期食管修复。我们报告了一例延迟超过两周的自发性食管破裂一期修复成功的病例。
一名53岁男性在外部医院被误诊为肺炎接受治疗后前来我院就诊。随后他被诊断为自发性食管破裂，先接受了内镜下套扎治疗，随后置入支架。持续向纵隔内渗漏使得有必要进行手术探查。探查时成功进行了一期修复。
延迟两周的食管穿孔内镜治疗失败后接受一期手术修复，未出现并发症。
即使晚期诊断的自发性食管破裂伴有治疗长时间延迟和内镜治疗失败，一期缝合仍可能成功。我们得出结论，如果组织仍有活力，对于自发性食管破裂患者应尝试进行一期手术修复。
