Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Clin J Gastroenterol. 2021 Apr;14(2):422-426. doi: 10.1007/s12328-021-01349-y. Epub 2021 Feb 1.
The patient was a 44-year-old man with a history of schizophrenia. He had a history of esophageal dysphagia and vomiting and presented with sudden strong epigastric pain. He was taken to a medical emergency center in a state of septic shock. Computed tomography revealed a left thoracic abscess, and esophageal rupture was suspected. He was referred to our department for treatment. Gastrointestinal series and gastrointestinal endoscopy revealed marked esophageal dilation and strong contraction of the lower esophageal sphincter. We, therefore, diagnosed the patient with empyema thoracis secondary to aspiration pneumonia due to esophageal achalasia. Conservative treatment with antibiotics and computed tomography-guided chest drainage was initiated, but the inflammation persisted. Thus, we successfully performed a per-oral endoscopic myotomy to manage achalasia symptoms.
患者为 44 岁男性，有精神分裂症病史。曾有食管吞咽困难和呕吐病史，并突发剧烈的上腹痛。他处于感染性休克状态，被送往医疗急救中心。计算机断层扫描显示左胸脓肿，怀疑食管破裂。他被转至我科治疗。胃肠造影和胃肠内镜显示食管明显扩张，食管下括约肌强烈收缩。因此，我们诊断患者为因食管失弛缓症导致的吸入性肺炎继发脓胸。给予抗生素保守治疗和 CT 引导下胸腔引流，但炎症持续存在。因此，我们成功实施了经口内镜肌切开术来治疗失弛缓症症状。
