初診時Mallory-Weiss症候群と診断された特発性食道破裂の1例

Spontaneous Esophageal Rupture Diagnosed Mallory-Weiss Syndrome at the Initial Medical Examination, Report of a Case

要旨　患者は56歳，男性．飲酒後の嘔吐と心窩部痛を主訴に来院した．来院時の食道内視鏡検査で食道胃接合部直上に深い潰瘍を認めたが，出血は認められなかった．胸部単純X線検査では，左側胸水が疑われたが縦隔気腫像は診断できなかった．Mallory-Weiss症候群の疑いで入院となったが，入院後胸部CT検査で縦隔気腫像を認め，また食道X線検査で縦隔内への造影剤の漏出を認めた．よって縦隔内限局型の特発性食道破裂と診断し保存的治療を施行した．その後の経過は良好で第32病日に退院となった．比較的まれな疾患ではあるが，胸・腹部の救急疾患の1つとして本疾患を認識しておくことが早期診断に重要であり，またminimally invasiveな治療法としての保存的治療法の有用性について述べた．

　A 56-year-old man complaining of vomiting after drinking and epigastralgia visited to our hospital. Endoscopic examination on admission revealed a deep ulceration without bleeding just above the esophagogastric junction. Chest plain radiography revealed a left pleural effusion, but we could not find mediastinal emphysema. This patient was suspected with Mallory‐Weiss syndrome. Chest computed tomography after admisson revealed a mediastinal emphysema. Esophagography revealed an intramediastinal leakage of contrast medium. Consequently we diagnosed intramediastinal spontaneous rupture of the esophagus. We performed conservative treatment. The clinical course was uneventful. This patient was discharged from our hospital on the 32 days. The early diagnosis is facilitated by the physician's awareness of this possibility of spontaneous esophageal rupture. Conservative treatment is useful as minimally invasive treatment of spontaneous esophageal rupture.