Gutiérrez del Olmo A, Loscos J M, Baki W, Nazal R, Nisa E, Ramirez-Armengol J A
Endoscopy. 1985 Mar;17(2):76-7. doi: 10.1055/s-2007-1018462.
Spontaneous intramural oesophageal perforation appears at any level, but preferably on the posterior wall, and is usually longitudinal. Unlike the Mallory Weiss and the Boerhaave syndromes, females are more frequently affected. It appears with sudden retrosternal pain radiating to the epigastrium, neck and back, followed by haematemesis of small quantity and dysphagia. Vomiting is rare. In contrast to complete rupture, neither pneumomediastinum nor emphysema is observed, barium swallow being the diagnostic test of choice whenever this pathology is suspected. However, when the symptoms are not typical, endoscopy is a useful method for diagnosis. Treatment must be conservative, while surgery is suggested in the case of recurrent symptoms or big intramural haematomas with a high risk of perforation. A 74-year-old woman is presented. Endoscopy was performed as an emergency in suspected food impaction in the oesophagus. This case was diagnosed as spontaneous intramural oesophageal perforation. The patient also presented with oesophageal diverticulum and hiatal hernia. Conservative treatment was given, and the lesion cured.
自发性食管壁内穿孔可发生于食管的任何部位，但好发于后壁，且通常为纵行穿孔。与马洛里-魏斯综合征和博赫哈夫综合征不同，女性更易受累。其起病时表现为突发的胸骨后疼痛，可放射至中上腹、颈部及背部，随后出现少量呕血及吞咽困难。呕吐少见。与完全性破裂不同，不会出现纵隔气肿或皮下气肿，当怀疑有此病时，食管吞钡造影是首选的诊断检查方法。然而，当症状不典型时，内镜检查是一种有用的诊断方法。治疗必须采取保守治疗，而对于复发性症状或有高穿孔风险的大的壁内血肿，则建议手术治疗。现报道一名74岁女性病例。因怀疑食管食物嵌塞而急诊行内镜检查。该病例被诊断为自发性食管壁内穿孔。患者还存在食管憩室和食管裂孔疝。给予保守治疗后，病变治愈。
