Treatment of Phlegmonous Esophagitis Combined with Mediastinitis

종격동염과 동반된 결합조직염식도염의 치료

  • I, Ho-Seok (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine) ;
  • Park, Chin-Su (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine) ;
  • Kim, Yeong-Dae (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine)
  • 이호석 (부산대학교 의학전문대학원 흉부외과학교실) ;
  • 박진수 (부산대학교 의학전문대학원 흉부외과학교실) ;
  • 김영대 (부산대학교 의학전문대학원 흉부외과학교실)
  • Published : 2007.10.05

Abstract

Phlegmonous esophagitis is a disorder in which bacterial infection occurs in the submucosal and muscular layers of the esophagus. This malady is very rare and it is usually associated with high mortality. A 69-year-old male was admitted with chest pain and fever he'd experienced for 7 days. The chest computerized tomography scan revealed mediastinal widening, circumferential esophageal thickening, an air shadow along the esophagus and right pleural effusion. Drainage and debridement of the mediastinum and primary repair of the perforated esophageal muscular layer through a right thoracotomy was done immediately. Further surgical treatment was not performed. He had a good oral intake without dysphagia or esophageal leakage at discharge.

결합조직염식도염은 식도의 점막하층과 근육층의 세균감염에 의해 발생하며 드문 질환이며 높은 사망률을 보인다. 69세 남자가 7일간의 흉통과 발열을 주소로 내원하였다. 흉부전산화단층촬영에서 종격동의 확장, 식도 주행을 따라 있는 식도벽의 비후와 공기 음영, 우측 흉수가 관찰되었다. 환자는 우측 개흉술을 통해 배농, 죽은조직제거술, 천공된 식도 근육층의 1차 봉합술을 시행 받았다. 추가 수술은 없었으며 퇴원시 식도 누출과 연하장애 없이 경구 식이는 원활하였다.

Keywords

References

  1. Walsh TJ, Belitsos NJ, Hamilton SR. Bacterial esophagitis in immunocompromised patients. Arch Inter Med 1986;146:1345-8 https://doi.org/10.1001/archinte.146.7.1345
  2. Goff JS. Infectious causes of esophagitis. Annu Rev Med 1988;39:163-9 https://doi.org/10.1146/annurev.me.39.020188.001115
  3. McDonald GB, Sharma P, Hackman RC, Meyers JD, Thomas ED. Esophageal infections in immunosuppressed patients after marrow transplantation. Gastroenterology 1985;88:1111-7 https://doi.org/10.1016/S0016-5085(85)80068-8
  4. Hsu CY, Liu JS, Chen DF, Shih CC. Acute diffuse phlegmonous esophagogastritis: report of a survived case. Hepatogasteroenterology 1996;43:1347-52
  5. Wakayama T, Watanabe H, Ishizaki Y, et al. A case of phlegmonous esophagitis associated with diffuse phlegmonous gastritis. Am J Gastroenterol 1994;89:804-6
  6. Mann NS, Borkar BB, Mann SK. Phlegmonous esophagitis associated with epiphrenic diverticulum. Am J Gasteroenterol 1978;70:510-3
  7. Jung C, Choi YW, Jeon SC, Chung WS. Acute diffuse phlegmonous esophagogastritis: radiologic diagnosis. Am J Roentgenol 2003;180:862-3 https://doi.org/10.2214/ajr.180.3.1800862
  8. Aviles JF, Fernandez-Seara J, Barcena R, Domiinquez F, Fernandez C, Ledo L. Localized phlegmonous gastritis: endoscopic view. Endoscopy 1988;20:38-9 https://doi.org/10.1055/s-2007-1018124