- 期刊
Fistula between Esophagust Subclavian Artery Caused by Foreign Body Penetration: Report of a Case
食道異物穿刺引發之食道鎖骨下動脈瘻管：病例報告
摘要
動脈食道瘻管是食道異物穿刺後極度少見且高度致命性的併發症。就目前所知醫學文獻報告，只有二病例報告。我們在此報告一例44歲男性，在吞食鴨骨不順之後發生脖子及胸部疼痛，十三天後併發大量吐血現象。食道鏡發現在離門齒25公分處有一食道黏膜撕裂傷。經緊急探查手術行上半部部分胸骨切開及左側頸部切開，發現在離左鎖骨下動脈2公分處有一食道瘻管並與以結紮控制，然而病患仍於術後隔日死於休克及大量輸血症候群併發多器官衰竭。 動脈食道瘻管之臨床表現相似於主動脈食道瘻管。臨床狀況之不穩定及急迫性使得診斷與處理極為困難，需要高度的懷疑、緊急食道鏡檢查；而成功的治療更需要及早的病患復甦處理，出血控制及正確的手術計畫。
關鍵字
無資料並列摘要
Arterio-esophageal fistula (AEF) is an extremely rare, life-threatening complication caused by esophageal foreign body penetration. To the best of our knowledge, there have been only two cases documented in the English literature. Herein we present a 44-year-old male with neck and chest pain after a problematic ingestion of duck bone. Exsanguinating hematemesis occurred thirteen days later. Esophagoscopy revealed an esophageal mucosal tear located at 25 cm from the incisors. A left subclavian arterio-esophageal fistula at 2 cm above the root of the artery was controlled via an oblique incision on the left of the neck with upper partial sternotomy, however, the patient died the day following the surgery from multiple organ failure due to prolonged shock and massive blood transfusion. The clinical presentation of AEF resembles that of the aorto-esophageal fistula (AoEF). The main difficulty in diagnosis and management caused by unstable clinical status and limited time available necessitates high suspicion and urgent esophagoscopy, and successful treatment requires early resuscitation, effective bleeding control, and proper surgical planning.
延伸閱讀
- Chiu, N. C., Chiang, J. H., Chiou, Y. Y., Chau, G. Y., Chou, Y. H., & Chang, C. Y. (2007). 異物吞食造成的腸穿孔：病例報告. 中華放射線醫學雜誌, 32(1), 45-49. https://www.airitilibrary.com/Article/Detail?DocID=10188940-200703-32-1-45-49-a
- Chen, C. H., Huang, C. J., & Liu, H. C. (2004). 異物導致之胸部食道穿孔及氣膿胸的外科治療－病例報告. 胸腔醫學, 19(4), 306-312. https://doi.org/10.29806/TM.200408.0013
- Cheng, C. H., Chen, M. J., Wang:施壽全, H. Y., & Chen, C. J. (2013). 食道潰瘍併發致命的動脈食道瘻管出血：一病例報告. 臺灣消化醫學雜誌, 30(4), 309-313. https://doi.org/10.6557/GJT.201312_30(4).0003
- 劉家源、彭明仁、林錫泉、黃常哲、鄭碩仁（1997）。鈍性外傷性氣管食道瘻管：一病例報告。中華民國急救加護醫學會雜誌，8(4)，169-175。https://doi.org/10.30018/JECCM.199712.0004
- 黃妙珠（1976）。食道靜脈瘤出血之處置。當代醫學，(29)，271-272。https://doi.org/10.29941/MT.197603.0014