Lakkanna Aayush, Gopalam Vivek, Rajender Guguloth, Manna Souvik
General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Cureus. 2024 Sep 4;16(9):e68660. doi: 10.7759/cureus.68660. eCollection 2024 Sep.
Esophageal cancer is more common with increasing age and rarely seen below the age of 45. The current case report is a case of squamous cell carcinoma of the esophagus in a 17-year-old male patient who presented with progressive dysphagia and significant weight loss. Contrast-enhanced computed tomography (CECT) neck, chest, and abdomen showed a lesion involving the middle and lower third of the esophagus with contiguous involvement of the gastroesophageal junction (GEJ), extending from D7 to D11 vertebral segments and completely occluding the lumen. He was managed with chemoradiation, in which three cycles of chemotherapy (Carboplatin 220 mg and Paclitaxel 80 mg) were given, followed by 18 fractions of 40Gy radiotherapy. After this period of chemoradiation, he developed weakness and breathlessness; he was not able to ambulate and became completely bedridden. He underwent a feeding jejunostomy for nutrition, then neoadjuvant chemoradiotherapy (NACRT) and oncological resection with thoracoscopy-assisted transhiatal esophagectomy. The patient had bubbles in the intercostal tube drain while doing incentive spirometry and basal crepitations, so on the next day, a gastric Conray was done, which showed a suspected contrast leak into bilateral lung fields. CECT neck, chest, and abdomen confirmed the minor leak and was managed conservatively. The abdominal wound developed erythema on the seventh day and was opened showing a small amount of sanguinopurulent discharge, for which daily dressing was done along with antibiotic cefuroxime. On the seventh and eighth days, the patient experienced hoarseness in their voice, a condition managed with supportive care. The patient was successfully discharged after completing all management protocols. The report clearly highlights the need to suspect malignancy in young adults presenting with dysphagia.
食管癌的发病率随年龄增长而升高，45岁以下较为少见。本病例报告为一名17岁男性食管鳞状细胞癌患者，表现为进行性吞咽困难和明显体重减轻。颈部、胸部和腹部的对比增强计算机断层扫描（CECT）显示，食管中下段有一病变，累及胃食管交界（GEJ），从第7胸椎至第11胸椎椎体节段，管腔完全闭塞。患者接受了放化疗，其中给予三个周期的化疗（卡铂220mg和紫杉醇80mg），随后进行18次40Gy的放射治疗。放化疗期间，患者出现虚弱和呼吸困难，无法行走，完全卧床。为补充营养，患者接受了空肠造口术，随后进行新辅助放化疗（NACRT），并通过胸腔镜辅助经裂孔食管切除术进行肿瘤切除。患者在进行激励肺活量测定时，肋间引流管有气泡，并有基底啰音，因此第二天进行了胃造影，结果显示双侧肺野疑似有造影剂渗漏。CECT颈部、胸部和腹部检查证实有少量渗漏，遂采取保守治疗。腹部伤口在第7天出现红斑，打开后可见少量血性脓性分泌物，每天进行换药，并使用抗生素头孢呋辛。在第7天和第8天，患者出现声音嘶哑，通过支持治疗进行处理。完成所有治疗方案后，患者成功出院。该报告明确强调了对出现吞咽困难的年轻成年人怀疑恶性肿瘤的必要性。
