自發性食道破裂

Boerhaave’s Syndrome

Boerhaave’s syndrome指的是因為食道內壓力驟增導致的自發性食道破裂。此病的死亡率相當高，且隨著治療時間的延誤而增加。然而由於此病非常的罕見，加上病患的臨床表現往往不典型，以及早期的胸部X光檢查不夠敏感，誤診或延誤診斷相當常見。本文報告一名85歲男性，飽餐過後出現胸痛、腹痛、及喘的症狀，5個小時後就醫時的胸部X光僅左下肺輕微浸潤增加，然而11個小時後的胸部X光出現明顯變化，電腦斷層顯示縱膈處有明顯的氣泡以及食道旁有異常的液體堆積，最後手術證實為此病。本文建議診斷未明且無法改善的胸痛應持續臨床觀察、反覆的身體檢查、以及重複胸部X光追蹤。 Boerhaave’s syndrome is spontaneous esophageal rupture resulting from a sudden increase in internal esophageal pressure. The mortality rate is very high and increases when treatments are delayed. However, this disease is not only very rare with atypical clinical manifestations, but also not sensitive enough to be detected by the early chest X-ray, so misdiagnosis or delay diagnosis are quite common. We reported a 85-year-old male who felt chest pain, abdominal pain and dyspnea just after having a big meal. When he visited emergency department 5 hours later, the chest X-ray revealed mild infiltration in left lower lobe. However, there was a significant change in the second chest X-ray 11 hours after onset. Computed tomography of chest revealed significant air bubbles in the mediastinum with fluid accumulation at the surrounding region of the esophagus. The following operation confirmed the diagnosis ultimately. We suggests that patients with unexplained and unimproved chest pain should be followed closely with repeated physical examinations and a series of chest X-rays.