| 摘要 |
This report describes our experience of successful surgical intervention of multiple esophageal perforations with delayed diagnosis in a 54 year-old male with alcoholic cirrhosis of the liver (Child B) resulting from endoscopic variceal ligation for bleeding. The patient presented with two episodes of perforation. The initial one was that of acute cervical esophageal perforation which was treated medically. During the second episode, delayed recognition led to right empyema and profound sepsis. Two weeks after the event, primary repair of the perforated esophagus plus local drainage for the cervical esophageal perforation and open window-drainage of the empyema resulting from thoracic esophageal perforation were carried out; decompressive gastrostomy and feeding jejunostomy were also performed. A second surgical operation was performed to place a T-tube at the site of cervical perforation because of poor drainage. Under broad spectrum-antibiotic treatment and continuous suction drainage of the perforation sites, the patient’s condition gradually improved, although he required a transient hemodialysis for acute renal failure during the postoperative course. The thoracic wound was closed with thoracoplasty and latissimus dorsi muscular transposition three months later. The oral intake was smooth without any esophageal symptoms at 1-year follow up. Multiple esophageal perforation is rare, and esophageal perforation is a potentially lethal condition, and a delay in diagnosis is the major factor contributing to its high morbidity and mortality. We hope that our experience will serve to improve the management of similar cases of multiple esophageal perforation, whether with or without delayed diagnosis, in the future. |
