Surgical Treatment of Thoracic Esophageal Perforation and Pyopneumothorax Induced by Foreign Bodies - A Case Report

異物導致之胸部食道穿孔及氣膿胸的外科治療－病例報告

陳兆弘(Chao-Hung Chen) ； 黃常哲(Chang-Jer Huang) ； 劉洪彰(Hung-Chang Liu)

《胸腔醫學》 19卷4期 (2004/08) Pp. 306-312

https://doi.org/10.29806/TM.200408.0013

摘要

食道異物梗塞好發於小孩及沒有牙齒的成年人，適時的診斷與積極的治療才可避免食道穿孔的嚴重後果，立即修補再加上活組織移植的強化方可降低術後併發症。我們報告一個延遲診斷的食道異物梗塞併發食道穿孔之成功外科治療經驗。這位五十八歲的婦人在吞下一大塊牛筋後立刻出現流口水及吞嚥困難的現象，隔天早上安排的硬式食道鏡只找到並取出一小部份的牛筋。病人的食道穿孔並未被發現，一直到她出現嚴重的敗血症及低血壓。胸部X光顯示有左側氣胸及積水，同時發現鼻胃管也跑到左側肋膜腔。胃鏡證實有一大塊牛筋卡在食道下段並造成食道穿孔。我們將食道穿孔處直接縫起來，並用肋間肌覆蓋在接合處。術後三個星期的食道攝影顯示在食道下段有一個食道憩室。隨後的追蹤病人復原良好。

關鍵字

食道穿孔 ； 食道異物梗塞

並列摘要

Esophageal foreign body impaction occurs commonly in children and edentulous adults. Timely intervention and aggressive management can effectively prevent the catastrophic result of esophageal perforation. Primary repair reinforced with a viable tissue graft can minimize postoperative complications. We report a case with a delayed diagnosis of esophageal perforation induced by food bolus impaction that was successfully treated by surgery. A 52-year-old female presented with saliva drooling and dysphagia immediately after swallowing a piece of hamstring. A rigid esophagoscopy performed the next morning failed to remove the whole food bolus. Esophageal perforation was not detected until the development of severe sepsis and hypotension. Chest radiography revealed left pyopneumothorax and a nasogastric tube in the left pleural cavity. A flexible panendoscope confirmed a food bolus impacted in the lower esophagus; esophageal perforation was also observed. The perforation was primarily repaired and buttressed with an intercostal muscle flap. An esophagogram taken three weeks after the operation showed a diverticulum in the lower esophagus. The subsequent follow-up was uneveniful.

並列關鍵字

esophageal perforation ； foreign body impaction