自发性食管巨大血肿1例并文献复习

Spontaneous giant intramural esophageal hematoma: a case report and literature review

目的探讨自发性食管血肿的病因、诊断、临床特点以及治疗方式。方法回顾性分析我科2018年5月收治的1例因血友病A导致的自发性食管血肿患者的临床表现、内镜表现、螺旋CT、基因检测等特点,并结合相关文献及既往经验分析该疾病。结果本例患者以胸痛、呕血、黑便为主要临床表现,经螺旋CT、内镜诊断为食管内血肿,后期经基因检测明确病因为血友病A,保守治疗后好转出院。结论血友病A导致的自发性食管巨大血肿发病率较低,在排除了食管异物、外伤、药物等原因后,结合典型内镜表现、基因检测可诊断该病。

Objective To explore the etiology,diagnosis,clinical characteristics and treatment of spontaneous intramural haematoma of the oesophagus(SIHO).Methods The clinical manifestations,endoscopic manifestations,spiral CT,genetic testing and other characteristics of the patient with spontaneous intramural esophageal hematoma caused by hemophilia A who was admitted into our department in May 2018 were retrospectively analyzed,and the disease was analyzed based on relevant literature and previous experience.Results In this case,chest pain,hematemesis and black stool were the main clinical manifestations.The patient was diagnosed as intraesophageal hematoma by spiral CT and endoscopy.According to the genetic testing,the spontaneous intramural esophageal hematoma was caused by hemophilia A,and the patient was discharged after conservative treatment.Conclusion The incidence of spontaneous giant intramural esophageal hematoma caused by hemophilia A is relatively low.After the exclusion of esophageal foreign bodies,trauma,drugs and other causes,the disease can be diagnosed in combination with typical endoscopic manifestations and genetic testing.