未经证实:Boerhaave综合征是一种罕见的,具有高死亡率的挑战性实体。因此,需要早期诊断和及时治疗。然而,尚未开发出标准化的技术,尤其是食管大破裂.
方法:一名69岁的女性患者,患有急性胸廓综合征,伴有突然发作的严重胸骨后疼痛,辐射到左半胸部,呕吐,以及与皮下气肿相关的食物摄入后开始的呼吸困难,低血压,和心动过速.进行了A-CT,露出食道穿孔,并诊断出Boerhaave综合征.患者被送往食管切除术和胃成形术。手术后的2,5年,病人没有长期并发症,只有吞咽困难。
未经证实:需要排除急性胸廓综合征的鉴别诊断;然而,通常会延误Boerhaave综合征的诊断.因此,早期诊断(<24小时)可能会影响该患者的预后。另一方面,食管切除术可以控制急性疾病并允许消化道重建。
结论:在大的食管破裂和合并脓毒性休克的患者中,食管切除术是控制感染源并允许早期消化道重建的一种选择。
UNASSIGNED: Boerhaave syndrome is a rare, challenging entity with high morbimortality rates. Therefore, early diagnosis and prompt treatment are needed. However, a standardized technique has not been developed, especially in large esophageal ruptures.
METHODS: A female patient of 69 years with an acute thoracic syndrome consistent with severe retrosternal pain of sudden onset, radiating to the left hemithorax, vomiting, and dyspnea that began after food intake associated with subcutaneous emphysema, hypotension, and tachycardia. An A-CT was performed, revealing an esophageal perforation, and Boerhaave syndrome was diagnosed. The patient was taken to esophagectomy and
gastroplasty. 2,5 years after the procedure, the patient was without long-term complications, and only dysphagia was present.
UNASSIGNED: The differential diagnoses of acute thoracic syndromes are needed to be ruled out; however, it usually delays the diagnosis of Boerhaave syndrome. Therefore, early diagnosis (<24 h) may impact this patient\'s outcomes. On the other hand, esophagectomy can be feasible to control the acute condition and permit a digestive tract reconstruction.
CONCLUSIONS: In patients with large esophageal ruptures and concomitant septic shock, an esophagectomy is an option to control the source of infection and to permit early digestive tract reconstruction.