Spontaneous esophageal rupture-Problems in diagnosis and therapy.:Problems in Diagnosis and Therapy
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We present 5 spontaneous esophageal ruptures experienced in our institute during past 10 years. All patients were males, with a mean age of 44.8 (range, 38-52) years. Epigastralgia without peritoneal signs was the chief complaint in 4 of 5 patients. Three of the 5 spontaneous esophageal ruptures were diagnosed or suspected at prior institutes, and the patients were transferred to our institute within 9.0 hours (mean) of the onset. The remaining 2, who were diagnosed as having pneumonia or Mallory-Weiss syndrome at prior institutes, required from 3 to 6 days before arrival. Plain chest roentgenograms showed pneumomediastinum in 4, pleural effusion in all, and pneumothorax in 3 of the 5 patients. Esophagography using water soluble contrast media and endoscopic examinations was diagnostic in all patients on whom it was performed. All patients underwent surgery. Primary closure with suturing was performed in 4 patients and a cervical esophagostomy (salivary diversion) was constructed in 1 case. One patient underwent esophageal resection, because esophageal necrosis had been obvious endoscopically before surgery. The number of bacterial species in the cultured pleural effusion tended to correlate with the time elapsed from rupture to bacterial examination (monomicrobial 10.3 hours versus polymicrobial 83.3 hours, mean). Among 3 patients whose ruptures were sutured primarily without esophagostomy, 2 had complications of leakage from the sutured site. No patient died. In conclusion, we emphasize that it is important to suspect spontaneous esophageal rupture if a patient complains of epigastralgia without peritoneal signs occurring after vomiting. In such cases, immediate diagnosis and initiation of therapy are advocated to reduce the morbidity and mortality of this disease.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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