![\"Obr.](\"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/wp-content\/uploads\/2013\/03\/Image_599.png\" "\\"Obr.")
<\/a>Obr. 6
Setk\u00e1n\u00ed s prof. R . Belseym na kon gresu v Lucembursku v roce 1995 (zprava: M. Duda, R . Belsey, S. Czudek)<\/p><\/div>\n
Z\u00e1v\u011brem t\u00e9to kapitoly si dovol\u00edm vzpomenout slavn\u00e9ho j\u00edcnov\u00e9ho chirurga prof. Ronalda Belseyho z Bristolu, se kter\u00fdm jsme po dlouh\u00e1 l\u00e9ta udr\u017eovali p\u0159\u00e1telsk\u00e9 i odborn\u00e9 kontakty (obr. 6). V 80. letech minul\u00e9ho stolet\u00ed na ot\u00e1zku \u201eJak by postupoval, kdyby m\u011bl u sv\u00e9ho pacienta intratorak\u00e1ln\u00ed dehiscenci anastom\u00f3zy?\u201c odpov\u011bd\u011bl: \u201eZavolal bych kn\u011bze.<\/em>\u201c Na\u0161t\u011bst\u00ed se na\u0161e mo\u017enosti od t\u011bch let zna\u010dn\u011b zm\u011bnily.<\/p>\nSpont\u00e1nn\u00ed ruptura j\u00edcnu (Boerhaave\u016fv syndrom)<\/h6>\n
Jde o onemocn\u011bn\u00ed vz\u00e1cn\u00e9, av\u0161ak historicky a patogenicky zaj\u00edmav\u00e9. Popsal je Boerhaave roku 1724 u velitele nizozemsk\u00e9 flotily admir\u00e1la Wassenaera, kter\u00fd podlehl ruptu\u0159e po excesu in Baccho [32].<\/p>\n
Etiologie<\/em>.<\/em> P\u0159\u00ed\u010dinou je n\u00e1hl\u00e9 zv\u00fd\u0161en\u00ed tlaku v j\u00edcnu vyvolan\u00e9 zvracen\u00edm, zvl\u00e1\u0161t\u011b v alkoholick\u00e9m opojen\u00ed, epileptick\u00fdm z\u00e1chvatem, porodem, nam\u00e1havou defekac\u00ed, zdvi\u017een\u00edm b\u0159emene apod. K roztr\u017een\u00ed st\u011bny j\u00edcnu dojde nej\u010dast\u011bji v posterolater\u00e1ln\u00ed \u010d\u00e1sti lev\u00e9 poloviny termin\u00e1ln\u00edho j\u00edcnu. Dispozi\u010dn\u00edm faktorem je chorobn\u011b zm\u011bn\u011bn\u00fd j\u00edcen p\u0159i ezofagitid\u011b apod.<\/span><\/p>\nKlinick\u00fd obraz a diferenci\u00e1ln\u00ed diagn\u00f3za.<\/em> V klinick\u00e9m obraze dominuje n\u00e1hl\u00e1 bolest, kter\u00e1 navazuje na zvracen\u00ed. Podle m\u00edsta perforace se stav jev\u00ed jako n\u00e1hl\u00e1 p\u0159\u00edhoda<\/span> hrudn\u00ed \u010di b\u0159i\u0161n\u00ed, kde je t\u0159eba vylou\u010dit (spont\u00e1nn\u00ed) pneumotorax, infarkt myokardu, disekuj\u00edc\u00ed aneuryzma aorty, perforaci \u017ealudku atd. Dal\u0161\u00ed pr\u016fb\u011bh onemocn\u011bn\u00ed se neli\u0161\u00ed od perforace j\u00edcnu jin\u00e9ho p\u016fvodu.<\/p>\nDiagnostika a l\u00e9\u010dba. Diagn\u00f3zu ov\u011b\u0159\u00edme kontrastn\u00ed pas\u00e1\u017e\u00ed j\u00edcnu vodn\u00fdm roztokem, z\u00e1sady l\u00e9\u010den\u00ed jsou stejn\u00e9 jako u jin\u00fdch druh\u016f perforace j\u00edcnu. I zde je progn\u00f3za z\u00e1visl\u00e1 na v\u010dasn\u00e9 diagn\u00f3ze a zah\u00e1jen\u00ed l\u00e9\u010dby [33, 34].<\/span><\/p>\nLiteratura<\/h3>\n\n- Hep A. Perforace j\u00edcnu. In: D\u00edt\u011b P, editor. Akutn\u00ed stavy v gastroenterologii. Praha: Gal\u00e9n; 2005: s. 41\u201347.<\/li>\n
- Vyhn\u00e1lek P, S\u00e1kra L, Dan\u011bk T, \u0160iller J, Havl\u00ed\u010dek K, H\u00e1jek J, Sillinger P. Endoskopick\u00e9 \u0159e\u0161en\u00ed iatrogenn\u00edho po\u0161kozen\u00ed j\u00edcnu. Rozhl Chir. 2006;85(1):6\u20138<\/li>\n
- Kle\u010dka J, \u0160im\u00e1nek V, Vodi\u010dka J, \u0160pidlen V, Pradl R, Ferda J. Akutn\u00ed mediastinitis \u2013 optim\u00e1ln\u00ed diagnostick\u00e1 a l\u00e9\u010debn\u00e1 opat\u0159en\u00ed. Rozhl Chir. 2009;88(5):253\u2013258.<\/li>\n
- Ferguson MK. Esophageal perforation and caustic injury: management of perforated esophageal cancer. Dis Esophagus. 1997;10:90\u201394.<\/li>\n
- Fernandez FF, Richter A, Freudenberg S, Wendl K, Manegold BC. Treatment of endoscopic esophageal perforation. Surg Endosc. 1999;13:962\u2013966.<\/li>\n
- Jones WG II, Ginsberg RJ. Esophageal perforation: a continuing challenge. Ann Thorac Surg. 1992;53:534\u2013543.<\/li>\n
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- White RK, Morris DM. Diagnosis and management of esophageal perforation. Am Surg. 1992;58:112\u2013119.<\/li>\n
- Duda M, Adam\u010d\u00edk L, Czudek S, \u0160krovina M, Velkoborsk\u00fd M, \u010cech B, Bezd\u011bk R, Merenda M, Kamler A. Miniinvazivn\u00ed \u0159e\u0161en\u00ed komplikac\u00ed v j\u00edcnov\u00e9 chirurgii. Slovensk\u00e1 chirurgia. 2010; 7(1\u20132):21\u201324.<\/li>\n
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- Duda M, Gryga A, Dlouh\u00fd M, Scheinarov\u00e1 A, Marek O, Moc\u0148\u00e1kov\u00e1 M. L\u00e9\u010dba perfora\u010dn\u00ed mediastinitidy. Rozhl Chir. 1996;75(1):31\u201333.<\/li>\n
- Vomela J. Mediastinitis acuta diagnostika a terapie. 1. vyd\u00e1n\u00ed. Brno: 2000; Acta facultatis Medicae Universitatis Brunensis Masarykianae (Sborn\u00edk prac\u00ed l\u00e9ka\u0159sk\u00e9 fakulty \u010d. 116 Masarykovy Univerzity Brno); 2000<\/li>\n
- Jan\u00edk M, Kraj\u010d T, Benej R, Haru\u0161tiak S. Aktu\u00e1lne trendy v limbe ak\u00fatnej mediastinit\u00eddy. Slovensk\u00e1 chirurgia. 2008;5(4):4\u20138.<\/li>\n
- Kauer WKH, Stein HJ, Dittler HJ, Siewert JR. Stent implantation as a treatment option in patiens with thoracic anastomotic leaks after esophagectomy. Surg Endosc. 2008;22:50\u201353.<\/li>\n
- Yano F, Mittal SK. Post-operative esophageal leak treated with removable silicone-covered polyester stent. Dis Esophagus. 2007;20:535\u2013537.<\/li>\n
- Al-Haddad M, Craig CA, Odell J, Pajaro O, Wallace MB. The use of self-expandable plastic stents for non-malignant esophago-pleural fistulas. Diseases of the Esophagus. 2007;20: 538\u2013541.<\/li>\n
- Nowakowski P, Ziaja K, Ludyga T. Kuczmik W, Biolik G, \u0106wik P, Ziaja D. Elf-expandable metallic stents in the treatment of post-esophagogastrostomy\/post-esophagoenterostomy fistula. Dis Esophagus. 2007;20:358\u2013360.<\/li>\n
- Johnsson E, Lundell L, Liedman B. Sealing of esophagel perforation or rupture with expandable metallic stent: a prospective controlled study on treatment efficacy and limitations. Diseases of the Esofagus. 2005;18(4):262\u2013266.<\/li>\n
- Langer FB, Wenzl E, Prager G, Salat A, Miholic J, Mang T, Zacherl J. Management of postoperatice esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg. 2005;79(2):392\u2013403.<\/li>\n
- Radecke K, Gerken G, Treichel U. Impact of self-expanding plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-enter experience in 39 patients. Gastrointest Endosc. 2005;61(7):812\u2013818.<\/li>\n
- Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, Lippert H, Pross M. Endoscopic treatment ot thoracic esophageal anastomosis leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61(7):891\u2013896.<\/li>\n
- Scileppi T, Li JJ, Iswara K, Tenner S. The use of a Polyflex coated esophageal stent to assist in the closure of a colonic anastomosis leak. Gastrointest Endosc. 2005;62(4):643\u2013645.<\/li>\n
- Gelbmann CM, Ratiu NL, Rath HC, Rogler G, Lock G, Sch\u00f6lmerich J, Kullmann F. Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomosis leaks. Endoscopy. 2004;36(8):695\u2013699.<\/li>\n
- H\u00fcnerbein M. Stroszczynski C, Moesta KT, Schlag PM. Treatment ot thoracic anastomosis leaks after esophagectomy with self-expanding plastic stents. Ann Surg. 2004;240(5):801\u2013807.<\/li>\n
- Doniec JM, Schniewind B, Kahlke V, Kremer B, Grimm H. Therapy of anastomotic leaks by means of covered self-expanding metallic stents after esophagogastrectomy. Endoscopy. 2003;35(8):652\u2013658.<\/li>\n
- Roy-Choudhury SH, Nicholson AA, Wedgwood KR, et al. Symptomatic malignant gastroesophageal anastomotic leak: management with covered methalic esophageal stents. Am J Roentgenol. 2001;176:161\u2013165.<\/li>\n
- Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR. Boerhaave\u2019s syndrome: analysis of the literature and report od 18 new cases. Dis Esophagus. 1997;10:64\u201368.<\/li>\n
- V\u00e1\u0148a J, Celec J, Ka\u010do L\u2019, B\u00edzik L. Prim\u00e1rne nepoznan\u00fd Boerhaave syndrom. Rozhl Chir. 2002;81(2):51\u201353.<\/li>\n
- Vyslou\u017eil K, Kr\u00e1l V, Klementa I, Blahut L, Kone\u010dn\u00fd M, Neoral \u010c. Chirurgick\u00e9 l\u00e9\u010den\u00ed spont\u00e1nn\u00ed perforace j\u00edcnu \u2013 Boerhaave syndrom. Rozhl Chir. 2000;79(11):521\u2013523.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
Do t\u00e9to kapitoly jsou za\u0159azeny patologick\u00e9 stavy spojen\u00e9 s r\u016fzn\u011b z\u00e1va\u017en\u00fdm po\u0161kozen\u00edm st\u011bny j\u00edcnu, kter\u00e9 mohou gradovat a\u017e v perforaci st\u011bny. Leh\u010d\u00ed stupn\u011b polept\u00e1n\u00ed st\u011bny j\u00edcnu a uv\u00e1zl\u00e1 ciz\u00ed t\u011blesa jsou zpravidla l\u00e9\u010deny gastroenterology, p\u0159i t\u011b\u017e\u0161\u00edm po\u0161kozen\u00ed st\u011bny a p\u0159i perforaci je nezbytn\u00e1 konzultace chirurga, mnohdy je nutn\u00e9 chirurgick\u00e9 \u0159e\u0161en\u00ed: polept\u00e1n\u00ed j\u00edcnu, ciz\u00ed t\u011blesa v […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":65,"menu_order":70,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-796","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/796","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=796"}],"version-history":[{"count":23,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/796\/revisions"}],"predecessor-version":[{"id":1297,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/796\/revisions\/1297"}],"up":[{"embeddable":true,"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=\/wp\/v2\/pages\/65"}],"wp:attachment":[{"href":"https:\/\/eportal.chirurgie.upol.cz\/portal_final\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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