In:
Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine, Wiley, Vol. 31, No. 6 ( 2020-06), p. 214-220
Abstract:
An 80–year–old woman who ingested an alkaline preparation with suicidal intent was admitted to our hospital with epigastric pain. Computed tomography (CT) showed a wall defect in the lower half of the esophagus, free gas in the mediastinum, and periesophageal fluid around the lower esophagus. A diagnosis of corrosive esophagitis with perforation was established, and a nasogastric tube was inserted for decompression and aspiration of the lower part of the esophagus. Conservative therapy was initiated, which included withdrawal of oral intake, and administration of an antimicrobial agent and a proton pump inhibitor. Parental nutrition was initiated on day 2. CT scan on day 7 revealed the persistence of free gas and fluid retention in the mediastinum. These signs, along with the inflammatory response assessed on blood biochemical investigation, showed improvement on day 28 of the clinical course. Dexamethasone was administered intravenously to prevent esophageal scarring between days 30 and 43. On day 41, endoscopic evaluation of the esophagus showed an ulcer in the healing phase that seems to be after esophageal perforation, but no perforation was detected; thus, administration of enteral nutrition was initiated. Oral intake was resumed on day 73, and no delayed onset complications were observed. Hence, our case highlights that in cases of corrosive esophagitis with perforation, even when presentation is delayed, if mediastinitis is localized, conservative management may be effective and lifesaving.
Type of Medium:
Online Resource
ISSN:
1883-3772
,
1883-3772
DOI:
10.1002/jja2.2020.31.issue-6
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
2846771-1
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