術後食道狭窄の1例
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概要
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A case of the recurrent anastomotic stricture after esophageal transsection in need of psychosomatic approach is reported. A 60-year-old Japanese woman was admitted with dysphagia, regurgitation, heart burn, tachycardia attack, insomnia, and anorexia. Soon after esophageal transsection for massive hematemesis from esophageal varices at the age of 58,she developed severe difficulties of food passage. In spite of conservative treatments with dilatation using bougir or endoscopic cutting for a period of two years, her complaing of dysphagia was not improved. X-ray studies on admission demonstrated severe stricture at the lower esophagus, She had in addition numerous clinical problems as cholecystitis, paroxysmal sinus tachycardia, unknown paralysis of lower extremities, and constipation. The patient was depressed and anxious about the prognosis of her illness. Psychosomatic treatments were conducted on admission. We first tried to correct her depressive and negative cognition by frequent interviews with her. At the same time, intensive dilatation using bougie was undergone on early days of her hospitalization. It appeared that altered cognitions had not a little influence on esophageal passage. On discharge she required bouginages only two times a month. Four years after discharge, she became able to resume her social life without bougienage. The lower esophageal stricture itself at the time of discharge, however, was not improved significantly in X-ray study. This fact may indicate that esophageal passage is frequently influenced by emotional factors in human.
- 1990-02-01
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