食管异物致主动脉食管瘘1例

<正>患者男,56岁,"误吞鸡骨1周,吐暗红色血痰2d"于我院就诊。患者1周前误吞鸡骨,到卫生所诊治,服药后异物感有所缓解,但觉背部疼痛,近2d吐暗红     

鱼刺致食管主动脉瘘1例报道

1病例介绍 患者,女,41岁.2008-05-14食鱼时不慎被鱼刺卡住,顿时感憋气,胸骨后至后背剧烈疼痛,伴大汗.     

食管结核合并食管支气管瘘1例

患者,男性,23岁,因“乏力3个月,进食呛咳1周”来院。3个月前无明显诱因出现乏力、纳差、盗汗、午后低热、消瘦、体质量降低,3个月内下降5 kg,无咳嗽、咳痰及咯血,无寒战及高热,无呼吸困难及胸痛,未行任何诊治。1周前出现进食时呛咳,进固体食物时呛咳较轻,进流食及饮水时呛咳较剧烈,同时出现咳嗽伴黄痰,轻微胸痛,因呛咳而不敢进食。查体:体温37.5℃,脉搏100次/min,呼吸24次/min,血压110/70 mm Hg(1 mm Hg=0.133 kPa),自动体位,查体合作,问答切题,慢性消瘦病容,全身皮肤黏膜无黄染及出血点,浅表淋巴结未触及;口唇无发绀,咽无充血,双扁桃体无…     

食管异物并发主动脉食管瘘8例报告

食管异物是耳鼻咽喉科常见急症之一，但食管异物并发主动脉食管瘘临床上较少见，预后极差。我院自1965～1997年共发现8例，现回顾性分析如下。1临床资料1．1一般资料：8例中，男7例，女1例，年龄25～63岁。异物种类：鸡骨6例，鹅骨1例，鱼骨1例。异物梗住后均有强吞食物四欲将异物推入胃内史。就诊时间：多数误梗异物后7～8天，最短3天，最长10天。1．2临床表现：主要是误吞异物后胸骨后疼痛或左胸隐痛。2例有疼痛缓解期，但出血前后都有疼痛加重。均伴有发热，白细胞升高。先兆性大出血时间，最短者吞人异物后4天，最长为9天，出血表现为吐…     

1例食管异物致主动脉食管瘘患者的护理

正食管异物并发主动脉食管瘘(aortoesophageal fistula,AEF)是食管异物的严重并发症,临床少见,死亡率极高。AEF典型的临床表现为Chari's三联征即胸骨后疼痛或吞咽困难、信号性出血、间歇期后致命性大出血~([1])。该病主要病因为食管异物及主     

成人先天性食管支气管瘘1例

1　病例报告男 ,2 4岁 ,因反复咳嗽、咯血 6个月 ,2 0 0 1- 0 2入院。 6个月前出现发热、咳嗽、咯血。经抗炎、止血等治疗后症状消失 ,后反复出现咳嗽、咯血。曾多次按肺炎、支气管扩张治疗。病程中无饮水及进流质食物呛咳史 ,无结核病及外伤史。查体 :发育正常 ,营养中等 ,左肺下部可闻及少量湿性罗音。胸部 X线示双肺纹理增强、紊乱 ,左下肺可见斑片状模糊阴影。胸部 CT示左肺下叶背段可见淡片状密度增高影 ,边缘模糊 ,内缘与纵隔分界不清。食管 X线钡餐检查示食管中、下段左侧壁可见约 2 cm的粘膜不规则 ,有造影剂外漏、堆积。纤维支气…     

异物致食管主动脉瘘1例的护理

食管主动脉瘘是心胸外科的急症,病情凶险。异物吞入在食管主动脉瘘的发病原因中占第二位,吞入物中鱼刺占首位。2011年1月,本院心胸外科成功抢救了1例食管主动脉瘘患者,现将护理报告如下。     

主动脉夹层支架置入术后致主动脉食管瘘1例

正主动脉食管瘘(aortoesophageal fistula,AEF)是一种预后凶险的疾病,多由食管异物、胸主动脉瘤和食管恶性肿瘤等引起。本文报道1例主动脉夹层动脉瘤支架置入术后2年发生AEF的案例,以提高对该病的认识。1临床资料患者男,52岁,因发热7 d于2015年8月22日入院。患者7 d前无明显诱因出现发热,体温最高40.7℃,伴寒战,无头痛、咽痛,无胸痛、咳痰,给予抗感染、对症治疗后好转;2 d前,再次出现发热。既往有高血压病史10余年,最高150/110 mmHg,口     

1例食管异物并发主动脉瘘的急救与护理

食管异物是五官科常见的急诊，主动脉瘘是其最凶险的并发症，患者往往在短时间内大量出血而死亡。苏州大学附属第二医院于2005年急诊收治1例食管异物患者，经积极抢救与精心护理，恢复良好。现将急救与护理体会报告如下。     

异物性食管-主动脉瘘2例救治体会

食管异物在临床上比较常见,但异物性食管-主动脉瘘罕见,且治疗棘手,现将本院收治的2例报告如下。临床资料例1,患者,男,47岁。误吞鸭骨后7d,呕血1h入急诊科病房,查体:发育正常,面色不苍白,脉搏90次/m in,体温36.8℃,血压128/75mmHg,呼吸18次/m in。初步诊断:上消化道出血,原因待     

Primary aortoesophageal fistula: A fatal outcome

Aortoesophageal fistula is a rare but life-threatening cause of massive gastrointestinal bleeding. We reported a case of primary aortoesophageal fistula associated with thoracic aortic pseudoaneurysm. Esophagogastroduodenoscopy demonstrated a bulging erosive lesion coated with fibrin. The patient was therefore diagnosed as malignant esophageal mesenchymoma initially. An emergency contrast-enhanced computed tomography revealed an out-pouching saccular aneurysm protruding toward the esophagus at the level of T8-9. The patient expired rapidly due to intractable massive bleeding. Assumptive diagnosis of esophageal malignancy leads to a loss of the most optimal time-point for operation thus negatively affecting the patient survival.     

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

BACKGROUNDAortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARYA 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.CONCLUSIONAlthough AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.     

Endovascular stent-graft treatment for aortoesophageal fistula induced by an esophageal fishbone: Two cases report

BACKGROUNDAortoesophageal fistula (AEF) induced by esophageal fishbones is a rare complication of esophageal foreign bodies and is very difficult to treat. Although the current view suggests that endovascular stent-graft treatment is useful for AEF, whether a subsequent thoracic operation is necessary remains controversial. The purpose of this report is to describe our experience using endovascular stent-graft treatment without combined thoracic operations for the treatment of AEF in two specific cases.CASE SUMMARYWe presented two cases of patients complaining of retrosternal discomfort treated in our department for an aortoesophageal fistula caused by the accidental ingestion of a fishbone. The two patients were effectively managed with combined means of endoscopic, medical (broad-spectrum antibiotic therapy, fasting, gastrointestinal decompression, etc.) and endovascular stent-graft treatment. The main difference in treatment was that the first patient presented with hematemesis after endoscopic removal of the fishbone. Subsequently, the patient underwent endovascular stent-graft treatment. The second case was managed with endoscopic removal of the fishbone with simultaneous endovascular stent-graft treatment, without any signs of hematemesis or melena. Both patients had successful postoperative management and were discharged home. Long-term follow-up is ongoing.CONCLUSIONThe treatment decision-making process should depend on the patients’ specific situations. Our practice indicates that endovascular stent-graft treatment without combined thoracic operations could be a valuable alternative in selected patients.     

表现为颈静脉血栓的肺癌副癌综合征1例

患者男,48岁,发现颈前区肿块一周就诊,临床医生要求行甲状腺检查.超声所见:①双侧甲状腺大小、回声正常;②右侧颈部实性混合回声团块(图1),范围约45 mm×20 mm,位于颈内静脉至锁骨下静脉汇合处管腔内,与管壁分界不清,探头加压后内径无明显减小,彩色血流显示肿块处无血流信号(图2),远端血流充盈良好;③右侧颈部血管周围探及多个肿大淋巴结回声,最大约24.8 mm×14.3 mm,形态欠规则,回声明显减低,皮髓质界限不清,无淋巴门结构,血流信号丰富;④左侧颈静脉内径正常,血流信号充盈好.     

胸主动脉瘤致主动脉食管瘘一例

主动脉食管瘘（AEF）是一种少见但预后极其凶险的疾病,处理不及时可引起严重感染和上消化道大出血。国内报道以食管异物引发的AEF常见,而国外报道则以大动脉疾病手术和主动脉瘤导致的AEF为主。该文报道1例胸主动脉瘤致AEF病例,患者为74岁男性,因降主动脉穿透性溃疡并假性动脉瘤破裂行主动脉支架植入术,术后发生AEF,并出现纵隔感染,在病情稳定后再次出现食管瘘口扩大及消化道出血,虽经积极抢救,但终因失血性休克死亡。临床上遇到有AEF高危因素和典型症状的患者应及早诊断,对于症状不典型的患者,接诊医师应拓宽诊断思路,提高警惕性,实施主动脉支架植入术后应注重广谱抗生素的应用,积极治疗纵隔感染。     

Secondary aortoesophageal fistula initially presented with empyema after thoracic aortic stent grafting: A case report

BACKGROUNDMassive upper gastrointestinal (GI) bleeding is usually urgent and severe, and is mostly caused by GI diseases. Aortoesophageal fistula (AEF) after thoracic aortic stent grafting is a rare cause of this condition, and has a poor prognosis with a high mortality rate. The clinical symptoms of AEF are usually nonspecific, and the diagnosis is often difficult, especially when upper GI bleeding is absent. Early identification, early diagnosis, and early treatment are very important for improving prognosis.CASE SUMMARYA 74-year-old man was admitted to the infectious disease department with > 10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers. Blood tests revealed elevated inflammatory indicators and anemia. Chest computed tomography (CT) showed postoperative changes of the aorta after endovascular stent graft implantation, pulmonary infection and pleural effusion. Pleural effusion tests showed empyema. After 1 wk of anti-infective treatment, temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion. Esophageal endoscopy was performed because of epigastric discomfort, and showed a large ulcer with blood clot in the middle esophagus. However, on day 11, hematemesis and melena developed suddenly. Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis. Thoracic and abdominal aortic CT angiography confirmed AEF. Later that day, he suffered massive hemorrhage and hemorrhagic shock. Eventually, his family elected to discontinue treatment.CONCLUSIONAEF should be strongly considered in patients with a history of aortic intervention who present with fever, especially with empyema.     

男性肺癌乳腺转移1例

患者男,89岁,发现右胸壁无痛性增大包块半月余.查体:右侧乳头凹陷,乳房外上象限可扪及一2.0 cm×2.0 cm大小包块,质硬,有压痛,表面光滑,活动度差,挤压乳头无溢液.     

罕见胆管-气管瘘 1例

患者女,71岁,5年前因肝细胞癌行肝右叶切除术,近一年因局部复发,曾接受数次经皮射频消融术及经肝动脉化疗栓塞术.患者近日出现发烧,咳嗽,痰多,痰中带有黄色物质并有苦味.腹部超声检查示右膈下和肝切缘处液体聚集.肝左叶内胆管扩张.血生化显示直接胆红素升高(127 mol/L).诊断胆管梗阻伴肺部感染,行经皮胆管引流术.