(Disclaimer: This article is for scientific use only, and the relevant information in the following content has been processed to protect patient privacy)
Abstract: A 77-year-old patient was admitted to the hospital due to progressive choking on food. The patient presented with progressive choking on swallowing and swallowing obstruction, and the possibility of esophageal lesions was considered. After examination, a clear diagnosis of esophageal malignancy was made, and the patient’s condition was effectively controlled after surgical resection, which went very well and the patient’s choking sensation and other uncomfortable symptoms disappeared.
Basic information】Male, 77 years old
Disease Type】Esophageal malignant tumor
Hospital】The Second Affiliated Hospital of Anhui Medical University
Date of Consultation】March 2022
Treatment plan】Surgical treatment (radical esophageal tumor surgery + mediastinal lymph node dissection) + enteral nutrition support with jejunal nutrition tube
Treatment period】20 days of hospitalization and 2 months of follow-up
Results】Surgery went well, and the choking sensation disappeared.
I. Initial consultation
The patient is a 77-year-old male with progressive choking for 5 months. The choking symptoms were not serious in the early stage, so he did not pay attention to them, but later the choking gradually worsened. Physical examination: clear consciousness, normal response, no enlargement of superficial lymph nodes in the neck and upper and lower clavicle, no deformity in the thorax, no pressure pain or percussion pain, breath sounds in both lungs, no dry and wet rales, no murmur in the heart valve auscultation area, heart rate of 76 beats/min, in rhythm. The outpatient upper gastrointestinal tract angiogram showed filling defect in the middle and lower esophagus, esophageal occupancy, and esophageal lumen stenosis, and esophageal tumor was considered. Chest CT showed thickening of the middle and lower esophagus, cranial CT showed no obvious infarct lesion, abdominal ultrasound showed no abnormality, and ECG was normal.
II. Treatment history
After admission, the diagnosis of esophageal malignant tumor was clear, and there were clear indications for surgery. The operation was performed under general anesthesia with two incisions on the right side of the chest and the middle of the abdomen, and middle and lower esophageal tumor resection + mediastinal lymph node dissection was performed successfully.
III. Treatment effect
After surgery, the patient achieved anatomical eradication of the tumor, and the surgical effect was definite. 1 week after surgery, no anastomotic fistula was observed by iodine upper gastrointestinal tract imaging, and the patient gradually tried to drink water and had a liquid diet, and swallowing choking disappeared. The length of hospitalization was 20 days. After 2 months of postoperative follow-up, the patient’s diet gradually returned to normal, her life was basically self-care, her weight gradually increased, and her quality of life was significantly improved compared with that before surgery.
IV. Notes
After the treatment, the patient’s symptoms have been improved, and as a doctor, we feel very happy about this. It is recommended that patients should be guided in their daily life and have confidence in their future life. If there is anxiety and it seriously affects normal rest, they need to seek medical treatment with oral sedative and hypnotic drugs as prescribed by the doctor.
And pay attention to the early postoperative diet is mainly liquid semi-liquid diet, gradually from thin to thick, before the transition to a normal diet. Since the surgery was performed to reconstruct the digestive tract, it is necessary to eat less and more meals to prevent reflux esophagitis, not to lie flat immediately after meals, and to sleep with the head and neck padded at 30° to prevent misaspiration, leading to aspiration pneumonia. And according to the pathology and stage, the patient is recommended to continue chemotherapy and radiation therapy to further consolidate the treatment effect.
V. Personal insight
With symptoms of swallowing obstruction, swallowing choking, especially with long-term heavy drinking habits, the patient has a family history of esophageal tumor, gastroscopy is recommended to clearly diagnose or exclude esophageal malignancy. Gastroscopy is the gold standard for diagnosing esophageal malignant tumor. Gastrointestinal tract imaging and chest CT examination have diagnostic value for middle and late stage esophageal malignant tumor. If the patient is diagnosed as esophageal malignant tumor, the condition can be effectively controlled after surgical resection + lymph node dissection. If the diagnosis of esophageal malignant tumor is as clear as this patient, the disease can be effectively controlled after surgical resection + lymph node dissection.