Gastrenterology Department, Centro Hospitalar de São João, Portugal.
Internal Medicine Department, Centro Hospitalar de São João, Portugal.
Rev Esp Enferm Dig. 2019 Sep;111(9):724-725. doi: 10.17235/reed.2019.6154/2018.
We report a unique case of acute esophageal necrosis in association with perforated acute cholecystitis and secondary Klebsiella pneumoniae bacteremia. An 83-year-old male with history of diabetes mellitus, dyslipidemia, ischemic cardiomyopathy and recent right hemicolectomy for colon adenocarcinoma presented to emergency department with acute epigastric pain and hematemesis. The patient appeared cachectic and dehydrated. He was afebrile and hemodynamically stable. Laboratory studies revealed anemia, leukocytosis, hyponatremia and hyperlactatemia. Esophagogastroduodenoscopy displayed characteristic features of acute esophageal necrosis. Abdominal computerized tomography revealed acute cholecystitis with perforation contained by the liver. Percutaneous cholecystostomy was performed. Fluid therapy, intravenous pantoprazole and bowel rest were started. Klebsiella pneumoniae was cultured in blood and bile and broad-spectrum antibiotic therapy was administered. The patient improved clinically and, three weeks later, esophagogastroduodenoscopy demonstrated nearly complete healing of esophageal mucosa. To our knowledge, this is the first case of acute esophageal necrosis in association with acute cholecystitis.
我们报告了一例与穿孔性急性胆囊炎和继发性肺炎克雷伯菌血症相关的急性食管坏死的独特病例。一名 83 岁男性，有糖尿病、血脂异常、缺血性心肌病和近期右侧结肠腺癌的病史，因急性上腹痛和呕血就诊于急诊。患者表现出消瘦和脱水。他无发热，血流动力学稳定。实验室研究显示贫血、白细胞增多、低钠血症和高乳酸血症。食管胃十二指肠镜显示出急性食管坏死的特征性表现。腹部计算机断层扫描显示急性胆囊炎伴穿孔被肝脏包裹。进行了经皮胆囊造口术。开始进行液体治疗、静脉注射泮托拉唑和肠道休息。在血液和胆汁中培养出肺炎克雷伯菌，并给予广谱抗生素治疗。患者的临床状况得到改善，三周后，食管胃十二指肠镜显示食管黏膜几乎完全愈合。据我们所知，这是首例与急性胆囊炎相关的急性食管坏死病例。
