Perforation of a gullet
Contents:
Description:
The spontaneous rupture of a gullet, so-called syndrome to Boerhaave, is one of the most serious illness which is followed by perforation of bodies of digestive tract. Duration of treatment and a lethality at patients with a spontaneous rupture of a gullet increase by several orders if the diagnosis is made later, than in 12 hours after perforation.
Symptoms of Perforation of a gullet:
Usually the first sign of perforation of a gullet is the sharp pain behind a breast tending to increase, amplifying at cough, swallowing, a deep breath. At a spontaneous rupture of a gullet intolerable pain arises most often during vomiting, is localized at a xiphoidal shoot, irradiates in an anticardium, a back, the left shoulder. Quickly arise hypodermic emphysema (over a clavicle and on a neck), sometimes a hematemesis. At tool perforation (endoscopy, бу a gullet greasing) hypodermic emphysema can develop in several hours after holding a procedure, especially at the small amount of damage. As the late signs of perforation of a gullet testimonial of development of inflammatory process in a mediastinum, serve fervescence, the short wind and tachycardia, a leukocytosis increased by SOE, a bystry aggravation of symptoms of the patient, increase of a toxaemia and shock, development of a hydropneumothorax.
Data of a clinical and electrocardiographic trial allow to exclude an acute myocardial infarction. The diagnosis is confirmed by X-ray inspection which allows to reveal air in a mediastinum or hypodermic emphysema, and at the message of a gullet with a pleural cavity (a thicket left) - a hydra - or a hydropneumothorax.
Reasons of Perforation of a gullet:
The swallowed foreign body, bullet and missile wounds of a neck and thorax can be the reasons of perforation of a gullet. Gaps and perforation of a gullet can arise at diseases of a gullet and a mediastinum, especially at tumors, periprotsessa, ulcers, corrosive burns, an aortic aneurysm. The overeating, alcoholic intoxication and vomiting assume to a spontaneous rupture of a gullet most often. It can sometimes occur at a strong physical tension, sudden increase in intra belly pressure, an external injury, during an epileptic seizure. However in some cases it is not possible to connect a spontaneous rupture of a gullet with any known factor.
Treatment of Perforation of a gullet:
Acute management includes anesthetics (introduction subcutaneously or intravenously 2 ml of 2% of solution of Promedolum or 1-2 ml of 2% of solution of pantopon, and also analgeziruyushchy mix intravenously - 2 ml of 50% of solution of analginum, 1 ml of 2,5% of solution of isopromethazine), transfer of the patient into parenteral food. At high temperature and other signs of an acute mediastinitis and a delay with hospitalization prescription of antibiotics of a broad spectrum of activity is necessary (intramusculary).
Hospitalization at perforation of a gullet urgent in surgical department.
