Boerhaave's Syndrome: Report of a Case

自發性食道破裂是一種相當少見且具高致命危險的急症。對臨床醫師而言，不論在診斷或是治療方面，都是一項挑戰。患者必須很快地被診斷出來，並儘快接受手術治療，以避免縱膈腔炎持續擴散惡化，併發敗血症與休克。但是，此病的臨床表現並不具特異性，而且臨床醫師經常被其症狀誤導，而延誤診斷。此急症越晚被診斷出來，其伴隨之死亡率越高。在這篇病例報告中，一位39歲女性病人因自行以手指刺激喉嚨催吐後，突然發生劇烈的胸痛與呼吸困難，而被送到本院急診室。首張胸部X光片發現有縱膈腔氣腫的情形，而3小時後在另一張胸部X光片上，可見到縱膈腔氣腫與肋膜腔積液。之後安排的胸部電腦斷層掃瞄，清楚地顯示口服的對比劑，經胸部食道外洩至縱膈腔裡。病患接受緊急開胸手術，直接修補破裂的胸部食道。在住院25天之後，順利康復出院。出院後在本科門診接受4個月的追蹤與檢查，並無發現任何後遺症。本文將回顧並討論這個罕見病例的診斷及處理方式。

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並列摘要

Spontaneous esophageal perforation (Boerhaave's syndrome) is an uncommon and potentially lethal condition that continues to pose a challenge both in diagnosis and treatment. It requires early diagnosis and immediate surgical intervention to prevent fulminant mediastinitis and septic shock, but clinical manifestations of this emergency are not specific and are often misleading. Thus, delayed diagnosis occurs frequently, and this condition is associated with a high mortality rate. We report a case of spontaneous rupture of the esophagus in a 39-year-old female, who presented to our emergency room with severe chest pain and dyspnea following self-induced vomiting. An initial chest radiograph revealed pneumomediastinum, and a rightsided pleural effusion was seen on another chest radiograph 3 hours later. A CT scan of the chest with a water-soluble oral contrast confirmed an intra-thoracic esophageal leak, and the patient underwent an emergency operation for primary repair. After a 25-day hospital stay, she was discharged without significant sequels and has now been followed up at the outpatient department for 4 months.

並列關鍵字

Spontaneous esophageal perforation ； Boerhaave's syndrome

國際替代計量

Boerhaave's Syndrome: Report of a Case

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