自发性食管破裂的外科治疗

目的探讨自发性食管破裂的早期诊断和及时正确的外科治疗以提高自发性食管破裂的治愈率。方法回顾性分析1989年2月至2008年6月收治的56例食管破裂患者临床资料及治疗经过,比较保守治疗与手术治疗的疗效和死亡率,24h内手术治疗与24h以上手术治疗的疗效和死亡率。结果56例自发性食管破裂患者中手术治疗的治愈率是81%,优于保守治疗的50%,P0.05;发病后24h内手术者91%治愈,24h以上手术者66%治愈,P0.05。结论自发性食管破裂早期诊断和早期手术治疗是提高治愈率的关键。     

A case of spontaneous submucosal dissection of the esophagus

We report a case of spontaneous submucosal dissection of the esophagus of a 58-year-old patient. In September 2005, he complained of chest pain followed by vomiting. Endoscopy showed an ulcerative lesion in the entire circumference of the middle esophagus. No malignant cells were observed in biopsy specimen. The patient received therapy with hyperalimentation, a proton pump inhibitor, and Alloid G. The lesion healed under conservative treatment with a good clinical course and without the development of stenosis. One year later, we performed 24-h pH monitoring and esophageal manometry to clarify the pathogenesis of submucosal dissection in this patient. There was no gastroesophageal reflux, but the manometry test revealed decreased amplitude in the portion of the esophageal lesion that was considered to be caused by fibrosis resulting from inflammation. Two years later, the patient had no complaint of dysphagia. Further follow-up is needed for such a case.     

A case of sarcoidosis with atypical high resolution CT findings]

A 36-year-old woman was referred to our hospital for investigation of erythema on the upper arms and thighs and abnormal radiological findings in the chest. A chest radiograph showed poorly defined fine nodules in both lung fields and high-resolution CT revealed fine nodular opacities with a random distribution throughout both lungs. No lymph node enlargement or peribronchovascular interstitial thickening were seen. Bronchoscopic evaluation revealed bronchial mucosal hypervascularity. Transbronchial lung biopsy and skin biopsy specimens showed noncaseating epithelioid cell granulomas. These findings confirmed the diagnosis of sarcoidosis. This is a rare case of sarcoidosis presenting with atypical high-resolution CT findings, which are difficult to differentiate from those of miliary tuberculosis or metastatic carcinoma.     

Chicken bone lodged in the upper esophagus: CT findings

The authors report a case of a chicken bone lodged in the esophagus at the cervicothoracic junction. Both the radiographic and endoscopic examinations of the esophagus had failed to detect the ingested bone, but computed tomography (CT) demonstrated it as an opaque fragment penetrating the esophageal wall.     

A case of leiomyosarcoma of the esophagus]

A 67-year-old woman was admitted on June 21, 1990 because of an abnormality on chest roentgenogram, a three-month history of palpitations on exertion, and a 2 kg weight loss. Chest roentgenogram revealed a huge mass in the posterior mediastinum. The results of needle aspiration cytology from the mass and celiac angiography were suggestive of leiomyosarcoma of the esophagus. The patient underwent tumor enucleation. The tumor originated from the lower-portion of the thoracic esophagus, measured 23 x 13 x 13 cm, and weighted 1110 g. The tumor was diagnosed as leiomyosarcoma histologically. Esophageal leiomyosarcoma is a very rare malignant tumor. The present case had no history of dysphagia in spite of the large tumor size.     

A case of Westermani Paragonimiasis with atypical change of CT findings]

A 47-year-old man presented with bloody sputum and a cavitary mass shadow was formed in his right middle lobe. Transbronchial lung biopsy revealed the presence of parasite eggs and eosinophil infiltration. Based on the positive reaction against Westermani Paragonimus by multiple dot ELISA, Westermani Paragonimiasis was diagnosed. The cavitary mass shadow disappeared after the treatment with Pragiquantel. This is a rare case of Westermani Paragonimiasis showing interesting changes of chest CT findings during its clinical course.     

Low pleural fluid amylase associated with spontaneous rupture of the esophagus

All previously reported determinations of pleural fluid amylase in Boerhaave's syndrome have demonstrated elevated values. We treated a patient with Sj?gen's syndrome who had a low pleural fluid amylase level and the concomitant unusual finding of leakage of esophageal contents into the right pleural space.     

自发性食管破裂的诊断及治疗进展

自发性食管破裂(SER),即Boerhaave综合征(BS),系指健康人突然发生非外伤性的食管壁全层破裂。SER为较少见的急性胸部疾患,常易误诊或延误治疗,严重危及生命,是致死频率较高的胃肠道穿孔性疾病之一。随着内镜技术的发展,此病治疗模式正在转变。此文拟就SER的发病机制、临床表现及治疗进展作一综述。     

Uncomplicated spontaneous rupture of pancreatic pseudocyst into stomach: A case report

Pseudocysts of the pancreas are not rare, but spontaneous perforation and/or fistulization occurs in fewer than 3% of these pseudocysts. Perforation into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity and through the abdominal wall has been reported. Spontaneous rupture of the pancreatic pseudocyst into the surrounding hollow viscera is rare and, may be associated with life-threatening bleeding. Such cases require emergency surgical intervention. Uncomplicated rupture of pseudocyst is an even rarer occurrence. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection without bleeding. A 67-year-old women with a large pancreatic pseudocyst resulting from a complication of chronic pancreatitis was referred to our institution. During hospital stay, there was sudden decrease in the size of epigastric lump. Repeat computed tomography(CT) revealed that the size of the pseudocyst had decreased significantly; however, gas was observed in stomach and pseudocyst along with rent between lesser curvature of stomach and pseudocyst suggestive of spontaneous cystogastric fistula.The fistula tract occluded spontaneously and the patient recovered without any complication or need for surgical treatment. After 5 wk, follow up CT revealed complete resolution of pseudocyst. Esophagogastroduodenoscopy revealed that the orifice was completely occluded with ulcer at the site of previous fistulous opening.