Ayazi Khosro, Samsami Majid, Qaderi Shohra, Farsad Sayed Mehdi, Tofigh Arash Mohammadi, Nematihonar Behzad, Tahmasbi Hamed, Bagherour Javad Zebarjadi
Department of Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Research and Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2021 Jan;78:197-200. doi: 10.1016/j.ijscr.2020.12.042. Epub 2020 Dec 23.
Tuberculosis is a multisystematic disease and is the most common cause of infectious disease-related mortality worldwide. Gastrointestinal tract is an uncommon site for extrapulmonary tuberculosis (TB). Esophageal TB is exceedingly rare.
We report a 22-years-old male with esophageal TB that presented in septic shock from esophageal perforation. Despite all measures including surgical intervention and aggressive support in the intensive care unit, patient passed away.
The most common mechanism for esophageal involvement is secondary to direct spread from mediastinal structures and/or spreading the inoculation of swallowed sputum, or hematogenous or lymphatic spread. Once the diagnosis of TB is established, antibiosis is the cornerstone of treatment. Surgery is reserved only for complications of TB such as fistula, abscess, strictures or perforation. Less than 50% of cases are diagnosed within 24 h, and delay in diagnosis lead to significant increases in the mortality.
In countries with high prevalence of TB, this diagnosis should be considered in those with esophageal perforation with no underlying etiology and medical treatment for TB should be initiated in addition to conventional treatment in appropriate group of patients.
结核病是一种多系统疾病，是全球传染病相关死亡的最常见原因。胃肠道是肺外结核（TB）的罕见发病部位。食管结核极为罕见。
我们报告一名22岁男性食管结核患者，因食管穿孔导致感染性休克。尽管采取了包括手术干预和在重症监护病房积极支持在内的所有措施，患者仍不幸去世。
食管受累最常见的机制是继发于纵隔结构的直接蔓延和/或吞咽痰液的接种传播，或血行或淋巴传播。一旦确诊为结核病，抗痨治疗是治疗的基石。手术仅用于治疗结核病的并发症，如瘘管、脓肿、狭窄或穿孔。不到50%的病例在24小时内得到诊断，诊断延迟会导致死亡率显著上升。
在结核病高发国家，对于无潜在病因的食管穿孔患者应考虑这一诊断，除对合适的患者群体进行常规治疗外，还应启动抗结核治疗。
