老年食管异物梗阻误诊为食管裂孔疝一例

Esophageal foreign body obstruction misdiagnosed with hiatal hernia in an elderly patient: one case report

食管异物梗阻是指各种原因导致异物梗阻于食管某一部位,常表现为吞咽困难、进食后呕吐、胸疼。该文回顾性分析1例老年人食管异物梗阻误诊病例,患者虽然有吞咽困难及胸痛食管异物梗阻的临床表现,但否认异物或较大食团吞咽史,2次CT检查均提示食管裂孔疝,急诊开胸术中探查得以纠正诊断为食管异物梗阻。术后顺利出院,随访1年无异常。食团梗阻伴下段食管扩张易误诊为食管裂孔疝,临床医师在临床工作中遇到吞咽困难、胸部疼痛等临床症状的患者,要考虑到食管异物梗阻的可能,尽量减少误诊误治。

Esophageal foreign body obstruction refers to foreign body obstruction in a certain part of the esophagus induced by a variety of causes,mainly manifested as dysphagia,vomiting after eating and chest pain.In this article,clinical data of one elderly patient with esophageal foreign body obstruction were retrospectively analyzed.In spite of dysphagia,chest pain and alternative clinical manifestations related to esophageal foreign body obstruction,the patient denied of any history of swallowing foreign body or large food bolus.Twice CT examinations prompted hiatal hernia.The patient was eventually diagnosed with esophageal foreign body obstruction by emergency thoracotomy exploration.The patient was successfully discharged after surgery and presented with no abnormality during postoperative 1-year follow-up.Food bolus obstruction complicated with lower esophageal dilatation is likely to be misdiagnosed with hiatal hernia.Clinicians should pay attention to patients presenting with dysphagia,chest pain and other clinical symptoms and consider the possibility of esophageal foreign body obstruction to avoid missing the diagnosis and misdiagnosis.