Acute Esophageal Perforation due to Alkali Ingestion Successfully Treated by Fundal Serosal Patch Repair

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  • KATO Noboru
    Osaka Prefectural Nakakawachi Medical Center of Acute Medicine
  • TOYAMA Kazushige
    Osaka Prefectural Nakakawachi Medical Center of Acute Medicine

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  • 胃底部漿膜パッチ術が奏効したアルカリによる急性期食道穿孔の1例
  • 症例 胃底部漿膜パッチ術が奏効したアルカリによる急性期食道穿孔の1例
  • ショウレイ イ テイブショウマク パッチジュツ ガ ソウコウ シタ アルカリ ニ ヨル キュウセイキ ショクドウ センコウ ノ 1レイ

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Abstract

A 54-year-old woman attempted suicide by drinking 300 ml of undiluted alkaline bleach (Haiter®) and vomited once. When she arrived by ambulance to our hospital about one hour later, she had mild lactic acidosis, and a plain chest X-ray showed extensive pneumomediastinum. Computed tomography (CT) showed esophagitis-related wall thickening and pneumomediastinum. On endoscopy, necrotic perforation of the lower esophagus was seen near the esophagogastric junction. The diagnosis was corrosive esophagitis with acute perforation.<BR>Although the perforation required closure, there was concern about causing further necrosis because the margins were indistinct. Therefore, fundoplication with fundal serosal patch repair of a large area including the perforation was performed. On day 27, esophagography showed no leakage or strictures, and on day 44, endoscopy confirmed mucosal repair and closure of the perforation.<BR>Alkali-induced corrosive esophagitis with acute perforation, although relatively uncommon, is potentially life-threatening. Suture closure requiring debridement is difficult when the necrotic margins are indistinct. Fundal serosal patch repair can be useful in these cases.

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