Emphysematous osteomyelitis of the spine mimicking esophageal rupture.
Emphysematous osteomyelitis of the spine mimicking esophageal rupture.
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类似于食管破裂的脊柱气肿性骨髓炎。
DOI：
10.1016/j.amjms.2022.07.010
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Junki Mizumoto
中科院分区：
文献类型：
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作者：
Junki Mizumoto
一名89岁日本女性糖尿病患者因发热及精神状态改变被转至急诊科。患者独居，因意识丧失病史不明。血清葡萄糖24.1 mmol/L。肉眼可见血尿。由于溶血，血样无法检测。怀疑脓毒症，给予静脉输注及抗生素治疗，因呼吸不稳定插管治疗。计算机断层扫描显示第8至第11胸椎周围有肺气肿，第8和第9胸椎骨内空气（图1a， B）。胆囊扩张伴胆总管结石也可见。我们一开始怀疑是食管破裂，因为在食管附近发现了肺气肿，并检查了上消化道内窥镜，没有发现破裂的迹象。然后我们怀疑急性胆管炎是脓毒症的原因。内窥镜逆行胆管造影显示胆囊结石梗阻及胆总管扩张，内窥镜括约肌切开术排出化脓性胆汁。静脉血和胆汁细菌培养均呈腐熟梭菌和大肠杆菌阳性。诊断为急性胆管炎和继发性肺气性骨髓炎。血管内溶血被认为是由于C. perfrigens感染。患者接受了重症监护、手术干预和长期抗生素治疗，病情得到改善。
An 89-year-old Japanese woman with diabetes mellitus was transferred to the emergency department because of fever and altered mental status. The patient lived alone, and her medical history was unclear because of loss of consciousness. The serum glucose level was 24.1 mmol/L. Gross hematuria was seen. The blood sample could not be tested because of hemolysis. Sepsis was suspected, and the patient was administrated intravenous infusion and antibiotics and was intubated because of unstable breathing.A computed tomography scan revealed emphysema around the 8th to 11th thoracic vertebrae and intraosseous air of the 8th and 9th thoracic vertebrae (Fig. 1 A, B). Dilatation of the gallbladder with choledocholithiasis was also seen. We at first suspected of esophageal rupture because emphysema was seen adjacent to the esophagus, and examined upper gastrointestinal endoscopy, which revealed no sign of rupture. We then suspected acute cholangitis as a cause of sepsis. Endoscopic retrograde cholangiopancreatography revealed obstructed gallstone and dilated common bile duct, and endoscopic sphincterotomy drained suppurative bile away. Bacterial culture of venous blood and bile both turned out to be positive of Clostridium perfrigens and Escherichia coli. The diagnosis of acute cholangitis and secondary emphysematous osteomyelitis was made. Intravascular hemolysis was thought to be due to C. perfrigens infection. The patient undertook intensive care, surgical intervention, and long-term antibiotics therapy, and her condition was improved.