Njølstad Tormund Haugland, Ohlsen Jonas Torp, Liedenbaum Marjolein Henrieke, Tvinnereim Jon Meyer, Bruserud Øyvind
Radiologisk avdeling, Haukeland universitetssjukehus.
Kirurgisk serviceklinikk, Haukeland universitetssjukehus.
Tidsskr Nor Laegeforen. 2024 Sep 23;144(11). doi: 10.4045/tidsskr.24.0145. Print 2024 Sep 24.
Spontaneous rupture of the oesophagus is a potentially fatal condition. Symptoms can vary and diagnosis can be challenging.
A woman in her seventies presented to the emergency department with sudden-onset epigastric pain after a meal. A computed tomography (CT) showed signs of oesophageal rupture. Upper gastrointestinal endoscopy revealed an oesophageal rupture, and a stent was placed. The patient developed fever, dyspnoea and hypotension after the procedure. Additional CT revealed increasing pleural effusion, pneumomediastinum and loculaments of air in the peritoneum, and a mediastinal abscess. Laparoscopy with lavage and debridement was performed. A catheter was placed in the abscess and a chest tube in her right hemithorax. The stent was removed after 27 days. Further investigation revealed eosinophil oesophagitis as the likely cause of her oesophageal rupture.
This case highlights the importance of early diagnosis and proper treatment of spontaneous oesophageal rupture. Treatment depends on the cause of the rupture and severity of the patient's condition.
食管自发性破裂是一种潜在的致命疾病。症状可能各不相同，诊断具有挑战性。
一名七十多岁的女性因餐后突发上腹部疼痛就诊于急诊科。计算机断层扫描（CT）显示食管破裂迹象。上消化道内镜检查发现食管破裂，并置入了支架。术后患者出现发热、呼吸困难和低血压。进一步的CT显示胸腔积液增加、纵隔气肿和腹膜内气腔，以及纵隔脓肿。进行了腹腔镜灌洗和清创术。在脓肿处放置了导管，并在右半胸放置了胸管。27天后取出支架。进一步检查发现嗜酸性粒细胞性食管炎可能是其食管破裂的原因。
本病例强调了食管自发性破裂早期诊断和恰当治疗的重要性。治疗取决于破裂的原因和患者病情的严重程度。
