魚骨による食道穿孔の１例

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  • A CASE OF ESOPHAGEAL PERFORATION DUE TO THREE PIECES OF FISH BONE

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A 56-year-old man treated for schizophrenia accidentally swallowed fish bones on September 29, 2003. Two days later, he started to run fever, so he was treated conservatively with an antibiotic, but he didn't recover, and he was referred to our hospital on October 6, 2003. A CT scan revealed a big air density extending to the mediastinum from the neck. On the same day, an emergency operation was performed under the diagnosis of acute mediastinitis caused by esophageal perforation due to fish bone. We attempted to drain pus out by making a transverse incision in the neck, but the inflammation extended along the mediastinum, so we made a right thoracotomy incision. Five drainage tubes were put in the chest beside cervical esophagus and mediastinum. After the operation, continuous irrigations through the drains were done and he responded well to the treatment and he was discharged on the 38th hospital day. Some cases of esophageal perforation could be successfully cured with conservative therapy, but most of the cases complicated with mediastinitis should be treated with emergency operations. It is important to diagnose as soon as possible and treat appropriately, because shorter the time from the perforation the prognosis is better.

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