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[食管异物计算机断层扫描表现的诊断意义]

[Diagnostic significance of computed tomography findings of foreign body in esophagus].

作者信息

Yazaki Tomotaka, Ooshima Naoki, Ishimura Norihisa, Sato Shuichi, Kinoshita Yoshikazu

机构信息

Department of Internal Medicine II, Shimane University, Faculty of Medicine.

出版信息

Nihon Ronen Igakkai Zasshi. 2018;55(4):668-674. doi: 10.3143/geriatrics.55.668.

Abstract

An 84-year-old male with dysphagia was referred to our hospital. Chest computed tomography (CT) showed a rectangular structure along with artificial air in the cervical esophagus. Endoscopy revealed a 'shogi' game piece in the same region shown in CT findings, which was recovered during the endoscopic procedure. From January 2006 to July 2017, we experienced a total of 84 cases of esophageal foreign bodies at our institution (49 males, 35 females; mean age 60 years). Among those cases, the most common foreign body in the esophagus was a food ball, though fish bones and pharmaceutical packaging materials have often been recovered from elderly patients. Chest CT was performed in 39 of those cases prior to an endoscopic examination, with a foreign body in the esophagus detected by CT in 37 (95%). In addition, the stopping portion, progression of inflammation, and presence of free air can be assessed with CT imaging, which provide important clinical information for a safer and faster subsequent endoscopic procedure. Recently, a report conducted outside of Japan noted that eosinophilic esophagitis (EoE) was the main cause of food stoppage in the esophagus. A second-look examination may be necessary to determine the presence of EoE causing such a foreign body blockage.

摘要

一名84岁吞咽困难男性被转诊至我院。胸部计算机断层扫描(CT)显示颈段食管有一矩形结构并伴有人工气体。内镜检查发现CT所示相同区域有一枚“将棋”棋子,在内镜操作过程中取出。2006年1月至2017年7月,我院共收治84例食管异物患者(男性49例,女性35例;平均年龄60岁)。在这些病例中,食管最常见的异物是食团,不过鱼骨和药品包装材料常从老年患者中取出。其中39例在进行内镜检查前进行了胸部CT检查,CT检测到37例(95%)食管有异物。此外,通过CT成像可评估异物的停留部位、炎症进展情况以及是否存在游离气体,这为后续更安全、快速的内镜操作提供了重要的临床信息。最近,日本境外的一份报告指出,嗜酸性食管炎(EoE)是食管食物梗阻的主要原因。可能需要再次检查以确定是否存在导致此类异物梗阻的EoE。

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