Okada Hiroki, Shiwaku Hironari, Yamashita Kanefumi, Ohmiya Toshihiro, Inoue Haruhiro, Hasegawa Suguru
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Asian J Endosc Surg. 2019 Jan;12(1):107-110. doi: 10.1111/ases.12481. Epub 2018 Apr 15.
Peroral endoscopic myotomy (POEM) is a groundbreaking procedure for treating esophageal achalasia, and many reports from various facilities have described its safety and efficacy. However, there have been few reports on adverse events. Here, we report a case of a patient with mediastinitis caused by delayed mucosal damage after POEM. This case was the most severe among all POEM cases at our hospital. A 58-year-old man had experienced dysphagia and chest tightness since he was around 50 years old. At a previous hospital, he had been diagnosed with nonerosive reflux disease and had undergone fundoplication. As his symptoms did not improve, he was referred to our department. POEM was able to be finished but a stable visual field could not be maintained throughout procedure because of strong esophageal contractions. From findings of endoscopy and esophagography after POEM, the patient was diagnosed mediastinitis caused by delayed esophageal perforation. In this case, conservative treatment (fasting, antibiotic therapy, and enteral feeding) was successful. However, the option to administer surgical treatment, such as drainage, must not be overlooked.
经口内镜下肌切开术（POEM）是治疗食管贲门失弛缓症的一种开创性手术，多家机构的许多报告都描述了其安全性和有效性。然而，关于不良事件的报道却很少。在此，我们报告一例POEM术后因黏膜延迟损伤导致纵隔炎的病例。该病例是我院所有POEM病例中最严重的一例。一名58岁男性自50岁左右起就出现吞咽困难和胸闷症状。他曾在之前的医院被诊断为非糜烂性反流病，并接受了胃底折叠术。由于症状未改善，他被转诊至我科。POEM手术得以完成，但由于食管强烈收缩，整个手术过程中无法保持稳定的视野。根据POEM术后的内镜检查和食管造影结果，该患者被诊断为食管穿孔延迟导致的纵隔炎。在本病例中，保守治疗（禁食、抗生素治疗和肠内营养）取得了成功。然而，也不能忽视进行手术治疗（如引流）的选择。
