Perforation ʻo Esophageal

ʻO kahi perforation esophageal kahi puka i ka esophagus. ʻO ka esophagus ka ʻai o ka paipu e hele ai i ka wā e hele ai mai ka waha a i ka ʻōpū.

Hiki i nā mea o ka esophagus ke hele i loko o ka wahi e pili ana i ka pahu (mediastinum), ke loaʻa kahi puka i ka esophagus. ʻO ka hopena pinepine kēia i ka maʻi o ka mediastinum (mediastinitis).

ʻO ke kumu maʻamau o ka perforation esophageal ka ʻeha ma ke ʻano he lāʻau lapaʻau. Eia naʻe, ʻo ka hoʻohana ʻana i nā mea hana maʻalahi hiki i kēia pilikia ke kākaʻikahi.

E loli pū ʻia paha ka esophagus ma ke ʻano he:

• He tumo
• ʻO ka reflux Gastric me ka ulceration
• ʻO ke kahakaha mua ma ka esophagus
• Ke ale nei i kahi mea haole a i ʻole nā ​​kemika caustic, e like me ka hoʻomaʻemaʻe home, nā paila disk, a me ka waikawa pākiko
• Ka hōʻeha a i ʻole ʻeha i ka umauma a me ka esophagus
• ʻO ka luaʻi ikaika (Boerhaave Syndrome)

ʻO nā kumu liʻiliʻi e pili ana i nā ʻeha i ka ʻāpana esophagus (hōʻeha kūpilikiʻi) a me ka hōʻeha ʻana i ka esophagus i ka wā o ke ʻoki ʻana o kahi mea ʻē aʻe kokoke i ka esophagus.

ʻO ka hōʻailona nui ka ʻeha ke hiki mua ka pilikia.

ʻO kahi perforation ma waena a i ʻole lalo o ka hapa nui o ka esophagus ke kumu:

• Pilikia i nā pilikia
• ʻEha ʻeha
• Nā pilikia hanu

E nānā kāu mea mālama ola:

• Hanu wikiwiki.
• Fiva.
• Kaomi haʻahaʻa.
• Helu puʻuwai wikiwiki.
• ʻO ka ʻāʻī a me ka ʻoʻoleʻa a me nā huʻa ea ma lalo o ka ʻili inā aia ka perforation ma ka ʻaoʻao kiʻekiʻe o ka esophagus.

Loaʻa paha iā ʻoe ka pale x-umauma e nānā ai:

• ʻO ke ea i loko o nā palupalu o ka umauma.
• Loli i kahe mai ka esophagus i kahi ākea a puni nā akemāmā.
• Pulupā naha. ʻO nā kukuna X i lawe ʻia ma hope o kou inu ʻana i kahi kala ʻino ʻole hiki ke kōkua i ke kiko ʻana i kahi o ka perforation.

Loaʻa paha iā ʻoe kahi loiloi CT umauma e nānā no kahi abscess i ka umauma a i ʻole ka maʻi ʻaʻai esophageal.

Pono ʻoe e ʻoki kino. Pili ka ʻoki kino i ka wahi a me ka nui o ka perforation. Inā pono ke kahakaha, ʻoi aku ka maikaʻi ma waena o 24 mau hola.

Hiki ke hoʻopili ʻia i ka mālama ʻana:

• Nā Fluids i hāʻawi ʻia ma o kahi aa (IV)
• ʻO nā antibiotic IV e pale a mālama i ka maʻi
• Ka ninini ʻana i ka wai a puni nā akemāmā me ka pahu pahu
• Mediastinoscopy e hoʻoneʻe i ka wai i hōʻiliʻili i ka wahi ma hope o ka umauma a ma waena o nā māmā (mediastinum)

E hoʻokau ʻia paha kahi stent i loko o ka esophagus inā ua kulu wale kahi wai liʻiliʻi. Hiki i kēia ke kōkua i ka hōʻalo i ke keʻoki.

Hiki ke hoʻōla iā ʻoe iho kahi perforation ma ka ʻaoʻao ʻoi loa o ka ʻāpana o ka esophagus inā ʻaʻole ʻoe e ʻai a inu paha no kekahi manawa. I kēia hihia, pono ʻoe i kahi ʻōpū hānai ʻōpū a i ʻole kahi ala ʻē aʻe e loaʻa ai nā mea momona.

Pono pono ke ʻoki kino e hoʻoponopono hou i kahi perforation ma ka waena a i ʻole nā ​​ʻāpana o ka esophagus. E mālama ʻia paha ka liu e ka hoʻoponopono maʻalahi a i ʻole ka hemo ʻana i ka esophagus, kaukaʻi ʻia i ka nui o ka pilikia.

Hiki ke holomua ke ʻano i ka haʻalulu, a ʻo ka make paha, inā ʻaʻole i mālama ʻia.

Maikaʻi ʻo Outlook inā loaʻa ka pilikia i loko o 24 mau hola o ka hanana. Ola ka hapa nui o ka poʻe ke hana ʻia ke kaha ma waena o 24 mau hola. E iho i lalo ke ola inā ʻoe e kali lōʻihi.

Komo pū nā pilikia:

• Ka hōʻino paʻa ʻana i ka esophagus (hoʻoliʻiliʻi a i ʻole ke koʻikoʻi)
• Hoʻokumu ʻia kahi hana i loko a puni ka esophagus
• ʻO ka maʻi i loko a puni nā māmā

E haʻi koke i kāu mea hāʻawi inā kūkulu ʻoe i ka pilikia ke hele ʻoe i ka haukapila.

E hele i ka lumi pilikia a kāhea paha iā 911 inā:

• ʻAkahi nō kou ʻoki poepoe a i ʻole kahi Tube i waiho ʻia i loko o ka esophagus a loaʻa iā ʻoe ka ʻeha o ka umauma, nā pilikia e ale ana a me ka hanu ʻana.
• He kumu hou aʻe kāu e kānalua ai loaʻa paha iā ʻoe kahi perforation esophageal.

ʻO kēia mau ʻeha, ʻoiai ʻaʻole maʻa mau, paʻakikī e pale aku.

Perforation o ka esophagus; Boerhaave maʻi

• ʻŌnaehana Digestive
• Nā ʻōnaehana ʻōnaehana Digestive

ʻO Maxwell R, Reynolds JK. Ka mālama ʻana i ka perforation esophageal. I: Cameron JL, Cameron AM, eds. ʻO ke kaʻoki lāʻau lapaʻau o kēia manawa. 12th ed. Piladelapia, PA: Elsevier; 2017: 73-78.

Raja AS. Hōʻeha Thoracic. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 38.