Ishibe R, Nakamura Y, Ikee T, Hayashida Y, Arata K
Department of Surgery, Akune Citizen Hospital, Japan.
Kyobu Geka. 1998 Jul;51(8 Suppl):706-9.
This paper presents a rare case of spontaneous rupture of the esophagus operated on 10 days subsequent to its onset. A 69-year-old male, who was diagnosed as acute pancreatitis, came to this department after 10 days of conservative therapy. Emergency examination including computed tomography, esophagoscopy and esophagography indicated spontaneous rupture of the esophagus. At operation, despite severe inflammation of the pleural cavity, a 2 cm horizontal tear at the left wall of the lower esophagus could be directly closed, and reinforced with fibrin glue. Postoperative decompression therapy prevented the rupture of the closure. The early symptoms resemble other emergency diseases, thus making correct diagnosis difficult. Early management is required for lifesaving, and preoperative aggressive exploration must thus be conducted. Postoperative management including through decompression of the gastrointestinal tract is also essential, regardless of the mode of operation.
本文报道了一例罕见的自发性食管破裂病例，该病例在发病后10天接受手术治疗。一名69岁男性，被诊断为急性胰腺炎，经过10天的保守治疗后来到我科。包括计算机断层扫描、食管镜检查和食管造影在内的急诊检查提示食管自发性破裂。手术中，尽管胸腔严重炎症，但食管下段左壁一个2厘米的横向撕裂口可直接缝合，并用纤维蛋白胶加固。术后减压治疗防止了缝合处破裂。早期症状与其他急症相似，因此难以做出正确诊断。为挽救生命需要早期处理，因此必须进行术前积极探查。无论手术方式如何，包括胃肠道充分减压在内的术后处理也至关重要。
