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Ann Geriatr Med Res > Volume 13(1); 2009 > Article
Journal of the Korean Geriatrics Society 2009;13(1):43-48.
DOI: https://doi.org/10.4235/jkgs.2009.13.1.43    Published online March 31, 2009.
A Case of Successful Conservative Treatment of Esophageal Perforation from Penetration of Esophageal Wall by a Fish Bone
Sang Ho Lee, Sang Un Seo, Sun Kyu Choi, Seung Wook Bak, Hwang Yong Ji, Kyung Uk Jo, Cheol Koo
Department of Internal Medicine, Yeosu Jeonnam Hospital, Yeosu, Korea. moses1004@naver.com
식도벽을 관통한 생선 가시에 의한 식도 천공의 성공적인 보존적 치료 1예
A 71-year-old man with a history of percutaneous transluminal coronary angioplasty(PTCA) was referred to our clinic with a one-day history of a continuous substernal chest pain radiating to his left shoulder. In retrospect, he experien- ced chest discomfort after eating fish one day before but did not seek medical attention then. An upper gastrointestinal endoscopy was performed. The cause was not visible during the advancement of the endoscope through the eso- phagus, but a small segment of a fish bone protruding from an ulcerative lesion in the lower esophagus was iden- tified while withdrawing the endoscope. The fishbone was immediately removed. A follow-up CT scan revealed pneumo- mediastinum. Now hemodynamically stable, the patient underwent conservative medical treatment including total parenteral nutrition(TPN) and intravenous antibiotic drugs. The patient made complete recovery. We report a case of a 71- year-old male found to have an esophageal perforation from an ingested fish bone, which was managed successfully with conservative treatment. A pertinent literature review is also included.
Key Words: Foreign bodies, Esophageal perforation, Mediastinitis
초 록

식도이물은 흔한 임상적 문제이지만, 진단이 늦거나 오진한다면 심각한 합병증을 초래할 수 있다. 따라서 식도이물과 연관된 임상적 증상은 주의를 기울여야 함이 중요하고, 합병증의 조기 진단과 조기 치료가 성공적인 치료에 필수적이다. 비록 식도 천공에 대한 치료 방법에는 아직까지 논란이 많지만, 신중하게 환자 각각의 상태에 맞는 개별화된 접근이 필요하다. 저자들은 71세 남자가 흉통을 주소로 내원 하였으나, 생선 가시에 의한 식도 천공과 급성 종격동염으로 진단받고 경미한 임상 양상을 보여 수술적 치료가 아닌 금식, 비경구 정맥영양요법과 항생제 투여에 의해 보존적 치료를 성공적으로 하였기에 이를 문헌고찰과 함께 보고하는 바이다.

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