NEJM:胃穿孔导致气腹-病例报道

2019-07-04 xing.T MedSci原创

探查性腹腔镜检查显示胃后壁有穿孔,没有腹腔液或其他小肠或大肠异常。认为胃破裂是由复苏期间急性胃扩张气压伤引起的。患者进行了穿孔手术修复。

患者为一名两岁半的男孩,在发热性上呼吸道疾病期间出现癫痫发作后被送往急诊就诊。目睹癫痫发作的成年人担心这名男孩已经呼吸停止并开始进行胸部按压和人工呼吸。大约1分钟后,男孩恢复知觉。

在体格检查中,他神志清醒,神经系统检查显示没有异常。他看起来很不舒服,腹部肿胀,呈鼓状,压痛。腹部射线照相显示气腹。没有发现肋骨骨折。探查性腹腔镜检查显示后壁有穿孔,没有腹腔液或其他小肠或大肠异常。认为破裂是由复苏期间急性胃扩张气压伤引起的。患者进行了穿孔手术修复。



患者在医院住了3天,没有观察到额外的胃肠道问题或癫痫发作。他从手术和上呼吸道疾病中恢复得很顺利。

在6个月后的一次随访中,他正常成长并发育良好。 

原始出处:

Alexandra Masson,et al.Pneumoperitoneum from a Gastric Perforation.N Engl J Med 2019;https://www.nejm.org/doi/full/10.1056/NEJMicm1814352

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    2019-11-07 JR19860227
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    2019-07-05 wgx308
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    2019-07-05 a pediatrics surgeon

    这样就可以发新英格兰?

    0

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    2019-07-04 小微940490

    mark

    0

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    2019-07-04 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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Intensive Care Med:心肺复苏导致胃穿孔

作者认为胃穿孔的原因:在气道不正确的情况下口对口人工呼吸导致胃膨胀,此时胸外按压会造成胃穿孔。

探案:不可轻视的消化道异物

患者于2018-05-07无明显诱因下出现中上腹胀痛,未予重视。次日出现高热伴寒战、大汗、恶心不适,Tmax39.5℃, 无呕吐、黑便等。至附近诊所输液4日(具体不详)后腹痛略好转,体温热峰有所下降。

非同寻常的胃穿孔,最终诊断意想不到……

看标题就知道这个病例不简单,的确,本以为是一个简单的胃溃疡胃穿孔,而最终诊断却令人大吃一惊。