胃底部漿膜パッチ術が奏効したアルカリによる急性期食道穿孔の1例  [in Japanese] Acute Esophageal Perforation due to Alkali Ingestion Successfully Treated by Fundal Serosal Patch Repair  [in Japanese]

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Abstract

症例は54歳,女性.自殺目的でアルカリ性漂白剤であるハイター<SUP>®</SUP>の原液を約300ml飲用し,嘔吐を1回伴った.約1時間後の救急搬入時,軽度の乳酸アシドーシスと胸部単純X線で広範な縦隔気腫を認めた.CTで食道炎による壁肥厚と縦隔気腫を認め,内視鏡検査で食道胃接合部近傍の下部食道に壊死穿孔を認めた.腐食性食道炎の急性期穿孔であり,穿孔部の閉鎖が必要であったが,壊死部の境界が不明瞭で更なる拡大が危惧されたため,fundoplicationを応用した胃底部漿膜パッチで穿孔部を中心に広い範囲を被覆した.第27病日食道造影で漏出や狭窄像を認めず,第44病日内視鏡検査で穿孔部は粘膜が進展して閉鎖しているのを確認した.<BR>アルカリによる腐食性食道炎における急性期穿孔は少ないが,重篤な病態である.壊死部の境界が不明瞭なためデブリドメントを要する縫合閉鎖が困難であり,胃底部漿膜パッチが有用と考えられた.

A 54-year-old woman attempted suicide by drinking 300 ml of undiluted alkaline bleach (Haiter<SUP>®</SUP>) and vomited once. When she arrived by ambulance to our hospital about one hour later, she had mild lactic acidosis, and a plain chest X-ray showed extensive pneumomediastinum. Computed tomography (CT) showed esophagitis-related wall thickening and pneumomediastinum. On endoscopy, necrotic perforation of the lower esophagus was seen near the esophagogastric junction. The diagnosis was corrosive esophagitis with acute perforation.<BR>Although the perforation required closure, there was concern about causing further necrosis because the margins were indistinct. Therefore, fundoplication with fundal serosal patch repair of a large area including the perforation was performed. On day 27, esophagography showed no leakage or strictures, and on day 44, endoscopy confirmed mucosal repair and closure of the perforation.<BR>Alkali-induced corrosive esophagitis with acute perforation, although relatively uncommon, is potentially life-threatening. Suture closure requiring debridement is difficult when the necrotic margins are indistinct. Fundal serosal patch repair can be useful in these cases.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(7), 1433-1438, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007583802
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    029183293
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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