微创食管切除术后一种罕见且严重的并发症:第一例由横结肠疝胸腔内穿孔引起的左侧张力性肺气肿。病例报告和文献综述

Karimzadeh Mostafa, Carmen Wolf, Johannes Austrup, Frederike Franke, Olav Jansen, M. Both, P. Langguth
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引用次数: 0

摘要

目前,越来越多的人选择微创手术方法来治疗食管远端肿瘤。在这里,术后裂孔疝被认为是一种潜在的严重并发症。在这种情况下,仍然不知道手术或保守治疗是可取的。在此报告中,我们详细介绍了一个62岁的男性患者,他在我们的急诊科出现了严重的胸痛。该患者在此事件发生前2年接受了微创食管切除术和胃上拉手术。急诊计算机断层扫描显示左侧张力性气胸,基于横结肠经裂孔疝,引起胸内闭合环阻塞并随后穿孔。立即开始手术治疗,横结肠可以成功地重新定位和切除。然而,患者在术后48小时内死于粪便性腹膜炎、纵隔炎和胸膜炎并发的术后感染性休克。我们提供这一罕见病例的详细描述,并提供有关胸内结肠疝的文献回顾。
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A rare and severe complication after minimally invasive esophagectomy: First case of a left-sided tension pneumothorax caused by intrathoracic perforation of the herniated transverse colon. Case report and literature review
Nowadays, a minimally invasive surgical approach is increasingly being chosen to treat distal esophageal tumors. Here, postoperative hiatal herniation has been identified as a potentially severe complication. In such cases, it is still not known whether surgical or conservative treatment is preferable. In this report, we elaborate the case of a 62-year-old male patient who presented at our emergency department with severe chest pain. This patient had undergone minimally invasive esophagectomy with gastric pull-up 2 years prior to this event. Emergency computed tomography revealed a left-sided tension pneumothorax based on transhiatal herniation of the transverse colon causing an intrathoracic closed-loop obstruction with subsequent perforation. Immediate surgical treatment was initiated and the transverse colon could be successfully repositioned and resected. Nevertheless, the patient died due to postoperative septic shock in the setting of fecal peritonitis, mediastinitis, and pleuritis within 48 hours after surgery. We provide a detailed description of this rare case and provide a review of the literature concerning intrathoracic colonic herniations.
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