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BMJ：22岁女性吃鱼竟吃出了食管穿孔-案例报道

2016-05-19 Mechront 译 MedSci原创

食管穿孔胸痛纵隔炎
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患者女，22岁，因严重胸痛就诊，该疼痛放射至颈部。当患者在海鲜餐厅吃鱼时首次出现胸痛，然后就一发不可收拾，在过去的24小时里，疼痛一直在恶化。患者的颈部X线如下图所示。椎前（A）和软组织（B）广泛存在气体，由胸部进入颈部的气体。提示患者食管穿孔。下面来一张没有气体的颈部X片以做对比。目前考虑患者的食管穿孔是由于摄入的鱼骨头所致，虽然在X片上没有发现明显的异物。一旦发现食管穿孔需要立即外科急救，因为

患者女，22岁，因严重胸痛就诊，该疼痛放射至颈部。当患者在海鲜餐厅吃鱼时首次出现胸痛，然后就一发不可收拾，在过去的24小时里，疼痛一直在恶化。

患者的颈部X线如下图所示。



椎前（A）和软组织（B）广泛存在气体，由胸部进入颈部的气体。提示患者食管穿孔。



下面来一张没有气体的颈部X片以做对比。



目前考虑患者的食管穿孔是由于摄入的鱼骨头所致，虽然在X片上没有发现明显的异物。一旦发现食管穿孔需要立即外科急救，因为病情可以出现迅速恶化，所以对患者还要密切监测血流动力学、纵隔炎和脓毒症相关表现。

本例患者血流动力学稳定，予以禁食和静脉抗生素治疗。CT没有发现穿孔位置和异物，因此没有进行外科干预，密切观察下，患者恢复良好。

原始出处：

David C Howlett,Joseph Dalby Sinnott,et al.Chest and neck pain in a 22 year old woman.BMJ 2016;353:i2757

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    2016-08-29 ylzr123

    深度好文，值得学习，赞！

    0

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    2016-07-25 gaoxiaoe

    #BMJ#

    0

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    2016-05-21 mengsong

    因为老板?

    0

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    2016-05-21 lanyan20020086

    #穿孔#

    0

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    2016-05-21 zhouqu_8

    #食管#

    0

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    2016-05-20 qixiaotong123

    我们经常有这种病例，为什么他能发表。

    0

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    2016-05-20 忠诚向上

    小心啊，小孩更要注意

    0

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    2016-05-20 1dd8c52fm63(暂无匿称)

    这得多倒霉！

    0

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    2016-05-20 fatalmelanie

    吃鱼要小心

    0