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胃镜检查时自发性食管破裂的内镜修复：一份符合CARE标准的病例报告。

Endoscopic repair of spontaneous esophageal rupture during gastroscopy: A CARE compliant case report.

作者信息

He Feiyun, Dai Mugen, Zhou Jiwang, He Jiansheng, Ye Bin

机构信息

Department of Gastroenterology, Lishui Chinese medicine hospital.

Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University.

出版信息

Medicine (Baltimore). 2018 Nov;97(48):e13422. doi: 10.1097/MD.0000000000013422.

DOI:10.1097/MD.0000000000013422
PMID:30508951
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6283190/
Abstract

RATIONALE

Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy.

PATIENT CONCERNS

A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. During the gastroscopy, he vomited severely, which was followed by severe left chest pain radiating into the back and upper abdomen. The diagnosis was made by computed tomography (CT) scan without delay. Enhanced CT showed extensive mediastinal emphysema, a small amount of left pleural effusion, and a 6 cm tear was confirmed in the lower esophagus posteriorly.

DIAGNOSES

The patient was diagnosed with an intrathoracic rupture type of spontaneous esophageal rupture.

INTERVENTIONS

The patient received endoscopic suturing techniques under endotracheal intubation, titanium clip clamping, and over the scope clip (OTSC) sealing.

OUTCOMES

The procedure was smooth and the patient recovered well after operation.

LESSONS

During gastroscopy, the risk of esophageal rupture should be considered due to sudden pain caused by severe nausea and vomiting. Esophageal rupture can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.

摘要

原理

大多数食管破裂是一种非常严重的危及生命的良性胃肠道疾病，死亡率很高。然而，在胃镜检查期间有少数自发性食管破裂的病例。

患者情况

报道了一名57岁男性，因食物梗阻接受常规诊断性胃镜检查。在胃镜检查期间，他剧烈呕吐，随后出现严重的左胸痛并放射至背部和上腹部。通过计算机断层扫描（CT）扫描立即做出诊断。增强CT显示广泛的纵隔气肿、少量左侧胸腔积液，并且在食管下段后方证实有一个6厘米的撕裂口。

诊断

该患者被诊断为自发性食管破裂的胸内破裂型。

干预措施

患者在气管插管下接受了内镜缝合技术、钛夹夹闭和套扎封闭术。

结果

手术过程顺利，患者术后恢复良好。

经验教训

在胃镜检查期间，由于严重恶心和呕吐引起的突发疼痛，应考虑食管破裂的风险。食管破裂可迅速导致严重的危及生命的感染，如脓胸和纵隔炎。因此，认识到这种情况很重要，以便能够迅速实施适当的治疗，增加获得良好结果的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/4edfd4baf84b/medi-97-e13422-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/73e3cfb44ff5/medi-97-e13422-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/6718b581eb95/medi-97-e13422-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/11c235fa9726/medi-97-e13422-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/e66c59981549/medi-97-e13422-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/4edfd4baf84b/medi-97-e13422-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/73e3cfb44ff5/medi-97-e13422-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/6718b581eb95/medi-97-e13422-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/11c235fa9726/medi-97-e13422-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/e66c59981549/medi-97-e13422-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b35b/6283190/4edfd4baf84b/medi-97-e13422-g005.jpg

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