Fékété F, Hay J M, Birbaud F, Lortat-Jacob J L
Nouv Presse Med. 1977 Mar 19;6(11):935-9.
Nine cases of severe gastrointestinal haemorrhage as the presentation of oesophageal lesions are reported. Haemorrhages complicating oesophageal varices, carcinoma of the oesophagus and oesophageal surgery were eliminated from the study, as were haemorrhages associated with hiatal hernias or Mallory-Weiss syndrome. Amongst these 9 cases of severe haemorrhage, 5 were due to an ulcer of the oesophagus, 2 to acute oesophagitis, 1 to rupture of the oesophagus and one to a traumatic aneurysm of the aorta rupturing into the oesophagus. The location and cause of bleeding were determined only 3 times before operation and only when a fibroscopic examination had been carried out. At fibroscopy, an irregular lesion responsible for a severe haemorrhage has every chance of being a benign ulcer and not a carcinoma. Treatment directed at the aetiology was carried out in 6 cases and success obtained in 3 patients. The aetiological diagnosis who was not made in 3 patients, who died. The aetiology, diagnosis and therapeutic approach required in such cases of severe haemorrhage of oesophageal origin are considered. In the light of these cases, a possible oesophageal aetiology should be considered as a possible cause of an unexplained severe gastrointestinal haemorrhage. An attempt at proving such a hypothesis by fibroscopy is necessary and, in general, urgent thoracotomy since the bleeding is in most instances of arterial origin.
本文报告了9例以严重胃肠道出血为表现的食管病变。研究排除了并发食管静脉曲张、食管癌及食管手术的出血病例，以及与食管裂孔疝或马洛里-魏斯综合征相关的出血病例。在这9例严重出血病例中，5例是由食管溃疡引起，2例是急性食管炎，1例是食管破裂，1例是主动脉创伤性动脉瘤破裂至食管。术前仅3次确定了出血部位和原因，且均是在进行纤维镜检查时确定的。在纤维镜检查中，导致严重出血的不规则病变很可能是良性溃疡而非癌。6例针对病因进行了治疗，3例取得成功。3例未做出病因诊断的患者死亡。本文讨论了此类食管源性严重出血病例所需的病因、诊断和治疗方法。鉴于这些病例，对于不明原因的严重胃肠道出血，应考虑食管病因的可能性。有必要通过纤维镜检查来证实这一假设，一般而言，由于大多数情况下出血源于动脉，需紧急开胸手术。
