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<Provider Id="sundheddkcms"> <Item Id="{E0429379-6F2A-45E8-93B3-288303F4E0B6}" Name="hul-i-spiseroeret" Type="PHContentPage" ParentProviderId="sundheddkcms" ParentItemId="{FAEC0D78-E48F-4186-B29A-42EC833E1843}" SortOrder="175" PublishDate="2008-10-15T09:06:00" DeleteDate="2999-12-31T00:00:00" PotItemType=""> <Content> <LinkListField Name="Spot2"> <LinkField linktype="internal">{A12FFEB9-7D21-4130-9428-1457C5AB696B}</LinkField> </LinkListField> <HtmlField Name="FactContent"><![CDATA[<h2>Fakta</h2> <ul> <li>Hul i spiserøret er en sjælden og farlig tilstand </li> <li>Det ses hyppigst som en (sjælden) komplikation til kikkertundersøgelse af spiserøret eller mavesækken, hvis der er indtaget fremmedlegeme (f.eks. knapbatteri) - eller hvis der igennem mange timer har siddet en fastklemt klump af føde</li> <li>Meget sjældent kan der komme hul på spiserøret efter voldsomme opkastninger</li> <li>Symptomerne kommer hurtigt med smerter, besvær med at synke og åndenød</li> <li>Behandlingen er som regel en kombination af ernæring i blodårerne (intravenøs), faste, antibiotika eventuelt i kombination med kirurgi </li> </ul>]]></HtmlField> <HtmlField Name="PageContent"><![CDATA[<p> </p> <p> </p> <h2>Hvad er hul i spiserøret? </h2> <img style="width: 200px; float: left; height: 330px;" alt="Hul i spiserøret" src="270C89C31F644C07ABBB8F98BEA28E25-200-330" text="Hul i spiserøret" height="330" width="200"> <p>Hul i spiserøret (øsofagusperforation) betyder, at der er opstået en revne i spiserøret. Revnen går gennem hele spiserørets væg, så der er hul ind til brysthulen.</p> <p>Det er en meget sjælden og alvorlig tilstand. Skaden ses hyppigere blandt mænd, især i alderen 50-70 år, men kan ramme personer i alle aldre. Revnen vil ofte ramme nederste del af spiserøret. Langt den hyppigste årsag er en komplikation til kikkertundersøgelse af spiserør/mavesæk.</p> <h3>Hvad er symptomerne?</h3> <p>Pludselige smerter, besvær med at synke og åndenød er de typiske symptomer. </p> <p>Smerten kan stråle om i ryggen eller til venstre skulder, og den kan forværres i forbindelse med, at man synker. Man udvikler hurtigt feber og bliver alment medtaget.</p> <h3>Hvilke symptomer skal man være særligt opmærksom på?</h3> <p>Ved såkaldt spontan øsofagusperforation (se nedenfor) har man typisk først haft kvalme og kraftige opkastninger, efterfulgt af kraftige smerter i nedre del af brystet og øverst i maven. Der vil ofte komme luftmangel og svære smerter i brystet med udstråling til ryggen, mellemgulv og bag brystbenet. </p> <p>Hvis det tager lang tid, før diagnosen stilles, vil der sive luft ud i underhuden fra hullet i spiserøret. Luften medfører, at huden føles lidt hævet, og så kan det knitre, når man trykker på huden.</p> <h3>Hvordan stilles diagnosen?</h3> <p>Normalt er symptomerne så typiske, at lægen/kirurgen straks får mistanke om tilstanden. Symptomerne på hul i spiserøret kan dog variere. I nogle tilfælde mangler de typiske symptomer, hvilket kan gøre det vanskeligt for lægen at stille diagnosen. Symptomerne vil oftest kunne sammenkædes med en nylig kikkertundersøgelse (gastroskopi).</p> <p>Når lægen undersøger den syge person, er vedkommende som regel meget påvirket af smerter og alment påvirket. Åndedrættet er hurtigt, og maven er hård og øm. Den syge kan være koldtsvedende, have feber og være i <a href="~/link.aspx?_id=CFC0A9DD18D546E99401FAA594D4BDF5&_z=z">shock</a>. Jo senere diagnosen stilles, jo alvorligere er tilstanden, da der udvikles <a href="~/link.aspx?_id=CFC0A9DD18D546E99401FAA594D4BDF5&_z=z">shock</a>, blodforgiftning og svigtende organer.</p> <p>Man anvender som regel <a href="~/link.aspx?_id=3DF0E2AA97584DCB83DA2508E99DDB7F&_z=z">CT-skanning</a> af brysthulen til at påvise hullet. Nogle gange vil man i stedet foretage en kikkertundersøgelse.</p> <h2>Hvorfor får man hul i spiserøret?</h2> <p>Som skrevet ovenfor er langt den hyppigste årsag til hul på spiserøret en komplikation til en kikkertundersøgelse, men komplikationen er meget sjælden i denne forbindelse. </p> <p>Hul i spiserøret kan også ses efter, at man har slugt fremmedlegemer så som knapbatteri, skarpe genstande f.eks. barberblade eller efter mange timer med fastsiddende klump af føde.</p> <h4>Spontan øsofagusperforation </h4> <p>Der kan også opstå såkaldt spontant spiserørshul. Dette skyldes i de fleste tilfælde kraftige og eventuelt vedvarende opkastninger (Boerhaaves syndrom). Ved kraftige opkastninger kan trykket i spiserøret øges. Dette kan fremprovokere en revne i spiserøret. Årsagen vil ofte være et stort forbrug af alkohol og overspisning.</p> <h2>Hvilken behandling er der? </h2> <p>Behandlingen skal startes med det samme. I første omgang består behandlingen i at bringe den syge person uden for livsfare. Dette gør man ved, at vedkommende får væske direkte i en blodåre og får anlagt et sug, som opsuger madrester samt den væske, der dannes i mavesækken. Patienten skal derudover faste.</p> <p>Man behandler med bredspektret antibiotika samt stærke smertestillende midler. Der vil ofte lægges en slange (dræn) med mange huller i til aflastning af spiserøret.</p> <p>Når diagnosen stilles hurtigt - i løbet af de første 24 timer efter hullet er opstået - vil man i tilfælde af små rifter ofte forsøge med ovenstående behandling alene. </p> <p>Hvis der er tale om et større hul, vil lægerne foretage et kirurgisk indgreb igennem brysthulen og bughulen eller i nogle tilfælde prøve at lukke hullet ved en kikkertundersøgelse gennem spiserøret. Et kirurgisk indgreb i brysthulen er ofte en stor operation. Det er ofte forbundet med et langt ophold på hospitalet - og efter udskrivelse en lang rekonvalescensperiode på op til flere måneder. </p> <p>Desværre kan symptomerne vise sig sent. Det medfører, at tilstanden i mange tilfælde vil være så langt fremskreden, at behandlingen bliver vanskeligere.</p> <p> Behandlingen følger de samme principper som ved tidlig diagnose.</p> <h3>Hvordan undgår jeg at få hul i spiserøret?</h3> <p>Hvis man har et stort forbrug af alkohol og samtidigt spiser for meget, har man en større risiko for at få spontan øsofagusperforation end andre. Stop af stort alkohol forbrug og overspisning vil dog langt fra altid kunne forebygge hul i spiserøret.</p> <p>Hvis man skal have foretaget en kikkertundersøgelse af spiserøret og har besvær med at synke, er det vigtigt at fortælle det til lægen inden undersøgelsen.</p> <h2>Hvordan udvikler sygdommen sig?</h2> <p>Omkring 80 % af patienterne kommer sig efter, at spiserøret er revnet. </p> <p>Jo længere tid der går, jo større er risikoen for, at man ikke overlever tilstanden. Hvis der går over et døgn, er det kun 1/3, der overlever. Jo mere syg man er, før hullet opstår, jo dårligere er prognosen.</p> <h3>Er hul i spiserøret farligt?</h3> <p>Ja. Når spiserøret sprænges, vil væske og madrester kunne passere fra spiserøret ud i brysthulen og i vævet, som omgiver spiserøret. </p> <p>Dette fører til en livstruende, voldsom betændelse i brysthulen og organer som lungehinde, lunger og hjerte. Der opstår hurtigt <a href="~/link.aspx?_id=83AF38669E8342D7AAAD0152FD4F6245&_z=z">blodforgiftning</a> - bakterierne spredes med blodet - og <a href="~/link.aspx?_id=CFC0A9DD18D546E99401FAA594D4BDF5&_z=z">shock</a> opstår. Mange organer hører til sidst op med at fungere.</p> <h3>Hvor hyppig er hul i spiserøret?</h3> <p>Det er en meget sjælden tilstand. Hul i spiserøret opstår næsten altid som en komplikation til en kikkertundersøgelse af spiserøret (skønsmæssigt hos langt mindre end 1 % af patienter som får foretaget kikkertundersøgelse).</p> <h2>Vil du vide mere?</h2> <ul> <li><a href="~/link.aspx?_id=3DF0E2AA97584DCB83DA2508E99DDB7F&_z=z">Røntgen af hjerte og lunger</a></li> <li><a href="~/link.aspx?_id=20EF4EB7F2334EB99F60F4586B312BCA&_z=z">Hul i spiserøret - tegning</a></li> <li><a href="~/link.aspx?_id=36A8D14AAA35479297E79A7590FF8C56&_z=z">CT-skanning af brystkassen</a></li> <li><a href="~/link.aspx?_id=6A81ED44F4C84B7EA47C70401E88D4FE&_z=z">Spontan øsofagusperforation - for sundhedsfaglige</a></li> </ul>]]></HtmlField> <TextField Name="DoctorsHandbookID">29350</TextField> <TextField Name="PageTitle">Hul i spiserøret</TextField> <TextField Name="NavigationTitle">Hul i spiserøret</TextField> <CheckBoxField Name="ShowInMenu">true</CheckBoxField> <CheckBoxField Name="ShowInContentField">true</CheckBoxField> <DateTimeField 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