종격동 농양이 동반된 자발성 점막하 식도 박리 1예
A Case of Spontaneous Submucosal Dissection of the EsophagusAccompanying Mediastinal Abscess
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
자발성 점막하 식도 박리는 직접적 외상이나 이물질 및 기계 조작 등의 뚜렷한 원인 없이 점막 열상을 통해 점막하층과 근육층 사이가 길게 박리되는 드문 질환으로 아직까지 명확한 원인은 밝혀져 있지 않다. 점막하 벽내에 혈종을 유발하며 식도염 소견을 나타내는 경우는 있지만 종격동 내에 농양을 형성하는 경우는 매우 드물다. 대부분 박리 및 혈종에 의한 흉통, 연하곤란 등의 증상으로 병원을 방문하며, 금식과 수액 요법 등의 보존적 치료만으로도 예후가 좋다. 저자들은 흉골하 동통, 연하곤란 및 연하통으로 개인의원에서 치료받다가 전원된 54세 남자 환자에서 심한 점막하 식도 박리와 함께 종격동 농양이 있어 부분적 식도 절제술, 배액 및 항생제 치료로 호전된 1예를 경험하였기에 보고한다.
Abstract
Spontaneous submucosal dissection of the esophagus (SDE) is a rare disease, in which spontaneous submucosal spot bleeding or intramural hematoma leads to the tearing of the layers between submucosa and muscle of the esophageal wall without any definitive cause, and the pathogenesis of SDE has not been well documented yet. Typical symptoms of SDE are chest pain, hematemesis, dysphagia, and odynophagia. The laboratory tests are usually normal and symptoms could be mild and ambiguous, so the diagnosis of SDE is conducted with endoscopy or esophagogram in most cases. The prognosis of SDE is usually very good with just conservative cares such as fasting and fluid therapy. Esophageal perforation complicated by SDE is very rare because symptoms od SDE usually bring the patients to hospital before perforation. Recently, we experienced a case of a 54 year-old male showing the endoscopic findings of SDE and complicated mediastinal abscess probably following esophageal perforation. The patient had social history of chronic heavy alcoholic ingestion and had symptoms of substernal pain, dysphagia, and odynophagia. The patient recovered after partial esophagectomy, abscess drainage and antibiotic therapy.
참고문헌 (19)
- "Spontaneous intramural rupture of the esophagus", 31, pp.845~849 (1990)
- "Spontaneous intramural rupture and intramural haematoma of the oesophagus", 35, pp.890~897 (1980)
- "Spontaneous submucosal dissection of the esophagus", 32, pp.795~797 (1993)
- "The diagnosis and management of esophageal perforations", 83, pp.246~248 (1991)
- "Diagnosis and recommended management of esophageal perforation and rupture", 42, pp.235~239 (1986)
- "Treatment of chronic contained spontaneous esophageal perforations", 13, pp.2~4 (2000)
- "Spontaneous submucosal dissection of the esophagus:a case report", 18, pp.202~210 (1998)
- "Spontaneous intramural hematoma of the esophagus", 18, pp.872~877 (1998)
- "Endoscopic treatment in a case with extensive spontaneous intramural dissection of the oesophagus", 10, pp.969~972 (1998)
- "Extensive spontaneous submucosal dissection of the esophagus:long-term sequential endoscopic observation and treatment", 55, pp.262~265 (2002)
- "Endoscopic incision of a septum in a case of spontaneous intramural dissection of esophagus", 35, pp.387~390 (2002)
- "A case of spontaneous submucosal dissection of the esophagus", 26, pp.141~145 (2003)
- "Endoscopic treatment of spontaneous intramural dissection of the esophagus:a case report", 27, pp.527~530 (2003)
- "Intramural rupture of the oesophagus", 3, pp.536~537 (1968)
- "Appropriate contrast media for evaluation of esophageal disruption", 144, pp.439~441 (1982)
- "Reappraisal of contrast media used to detect upper gastrointestinal perforation:comparison of ionic water-soluble media with barium sulfate", 144, pp.231~237 (1982)
- "Submucosal dissection of the esophagus;a case report", 23, pp.95~97 (1991)
- "Analysis of prognostic factors in esophageal perforation", 34, pp.477~484 (2001)
- "Intramural rupture and intramural hematoma of the oesophagus", 72, pp.958~960 (1985)