Department of Thoracic Surgery, University Hospital of Athens, Greece.
2nd Department of Critical Care, University Hospital of Athens, Greece.
Pol Merkur Lekarski. 2022 Feb 22;50(295):37-39.
Esophageal perforations of any cause may escape early diagnosis and progress to lethal mediastinitis despite aggressive management. The treatment and outcome depends on the extent and chronicity of the injury.
We present a case of a late-diagnosed cervical esophageal rupture treated successfully with external vacuum therapy. A blunt trauma patient with cervical vertebral column fractures underwent fixation with a titanium bracket. A procedure-related esophageal perforation created an open fistulous communication to the skin. This was diagnosed with one month's delay. In diagnostic endoscopy the prosthesis was visible through a large esophageal defect. Evidence of mediastinitis was absent. The external wound was explored and a standard vacuum device was inserted. Nine weeks of continuous vacuum therapy achieved complete fistula closure and prevented infection. Mediastinitis was avoided and complete oral feeding was resumed.
Different clinical presentations indicate surgical, endoscopic or conservative treatment. In this report, we provide the ground for discussion for the alternative application of the vacuum technology in a case where otherwise surgery would be the definite treatment.
背景： 尽管采用了积极的治疗方法，任何原因导致的食管穿孔仍可能早期诊断并进展为致命性纵隔炎。治疗和预后取决于损伤的程度和慢性程度。
病例报告：我们报告了一例迟发性颈段食管破裂的病例，成功地采用了外部真空治疗。一位钝性创伤患者颈椎骨折，用钛支架固定。与手术相关的食管穿孔导致与皮肤相通的开放性瘘管。这是在一个月的延迟后诊断出来的。在诊断性内镜检查中，通过一个大的食管缺损可以看到假体。没有纵隔炎的证据。对外部伤口进行了探查，并插入了标准的真空装置。9 周的持续真空治疗实现了完全瘘管闭合并防止了感染。避免了纵隔炎，并恢复了完全口服喂养。
结论：不同的临床表现提示手术、内镜或保守治疗。在本报告中，我们为真空技术在这种情况下的替代应用提供了讨论的基础，否则手术将是明确的治疗方法。
