Climaco Kevin, Roubik Daniel, Gorrell Robert
General Surgery Department, William Beaumont Army Medical Center, El Paso, TX, USA.
Surg Case Rep. 2021 Nov 20;7(1):245. doi: 10.1186/s40792-021-01311-7.
Having a broad differential and knowing how to manage the different possibilities in a patient with chest pain is important. Esophageal bezoars are rare entities and are even less common in patients without any recent hospitalizations, known achalasia, or nasogastric tubes. Despite their rarity, having it in one's differential, and knowing how to manage it is important.
This case presents a patient with mega-esophagus secondary to an esophageal bezoar; and runs through the gamut of morbid chest pathophysiology, its differential, work-up, and management. The case is interesting in that the patient's initial presentation brings to mind a bevy of feared chest issues to include myocardial infarction, dissection, pulmonary embolus, achalasia, and perforation.
This clinical case highlights more than just the rare diagnosis of esophageal bezoar. It also goes through initial resuscitation, key concerns, "can't miss diagnoses", and finally discusses the feared end state of an esophageal perforation.
具备广泛的鉴别诊断能力并知晓如何处理胸痛患者的不同可能性至关重要。食管粪石是罕见的病症，在近期无住院史、无已知贲门失弛缓症或未置入鼻胃管的患者中更为少见。尽管它们罕见，但将其纳入鉴别诊断范围并知道如何处理很重要。
本病例呈现了一名因食管粪石继发巨食管的患者；并贯穿了病态胸部病理生理学的各个方面、其鉴别诊断、检查及处理。该病例的有趣之处在于患者的初始表现让人联想到一系列令人担忧的胸部问题，包括心肌梗死、夹层动脉瘤、肺栓塞、贲门失弛缓症和穿孔。
本临床病例不仅突出了食管粪石这一罕见诊断。它还涉及初始复苏、关键关注点、“不能漏诊的诊断”，最后讨论了令人担忧的食管穿孔终末状态。
