Wang Dong, Gao Chao-Bing
Department of Otorhinolaryngology Head and Neck, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.
World J Clin Cases. 2019 Dec 6;7(23):4130-4136. doi: 10.12998/wjcc.v7.i23.4130.
Herein, we report a case in whom two foreign bodies entered the upper mediastinal cavity from the cervical root and subsequently the esophagus. Surgery is the preferred treatment method, and operational procedures depend on the size and location of the foreign body relative to the mediastinal vessels. Rigid esophagoscopy combined with angle endoscopic surgery was selected to avoid surgical trauma and complications.
A 63-year-old male patient with a 6-mo old history of neck trauma presented with a black-brown foreign body in the lateral wall of the esophagus. Neck and chest computed tomography (CT) revealed that two superior mediastinal foreign bodies penetrated the esophagus diagonally. We removed two foreign bodies through an esophagoscope. Owing to the rigid working channel of esophagoscope and good exposure of endoscope, the risk of injury to the adjacent vital tissues was minimized. Postoperative comprehensive therapies, including antibiotic administration and nutritional support, resulted in a prompt postoperative recovery. Postoperative CT confirmed the absence of a residual foreign body and neck and chest infections. In addition, upper gastrointestinal angiography and gastroscopy revealed the absence of an evident esophageal perforation. The patient received an oral diet and did not experience any complication at the time of discharge from the hospital.
Rigid esophagoscopy combined with angle endoscopy is an effective, minimally invasive treatment for penetrating neck injuries.
在此,我们报告一例有两个异物从颈部根部进入上纵隔腔并随后进入食管的病例。手术是首选的治疗方法,手术操作取决于异物相对于纵隔血管的大小和位置。选择硬式食管镜联合角度内镜手术以避免手术创伤和并发症。
一名有6个月颈部外伤史的63岁男性患者,食管侧壁有一个黑褐色异物。颈部和胸部计算机断层扫描(CT)显示两个上纵隔异物斜穿食管。我们通过食管镜取出了两个异物。由于食管镜的刚性工作通道和内镜的良好暴露,相邻重要组织的损伤风险降至最低。术后综合治疗,包括使用抗生素和营养支持,使患者术后迅速康复。术后CT证实无残留异物以及颈部和胸部感染。此外,上消化道血管造影和胃镜检查显示无明显食管穿孔。患者出院时恢复经口饮食,未出现任何并发症。
硬式食管镜联合角度内镜是治疗穿透性颈部损伤的一种有效、微创的方法。