"The ghost door is closed, it's really unforgettable! Uncle Liao, who was lying on the hospital bed, had palpitations, he didn't expect that he coughed after drinking once, and he coughed until his esophagus ruptured.
Overnight surgery for 8 hours to "repair" the esophagus.
Recently, Uncle Liao was rushed to the emergency department of Guangdong Provincial Hospital of Traditional Chinese Medicine after a violent cough and severe pain in his chest and abdomen. At that time, he had persistent pain in his chest and abdomen, his expression was sluggish, and he was in critical condition. CT examination of the chest and abdomen revealed a small amount of pneumothorax and pleural effusion on the left side, most likely a hiatal hernia. The emergency physician immediately informs the Department of Thoracic and General Surgery for urgent consultation. After receiving the notice, Dr. Li Yongfeng of the Department of Thoracic Surgery rushed to the emergency department in three steps and two steps, and after a detailed medical history, a comprehensive physical examination and comprehensive related examination data, the Department of General Surgery temporarily ruled out an acute abdomen, Dr. Li Yongfeng highly suspected that the patient was a ruptured esophagus, and immediately used bedside B ultrasound positioning to perform diagnostic thoracentesis with a syringe, and extracted a dark brown turbid liquid, accompanied by a little esophageal residue, and the diagnosis of spontaneous esophageal rupture was established. Urgent thoracostomy was performed for the patient at the bedside, and about 700 ml of dark brown intrathoracic digestive fluid was immediately drained, and the indwelling gastric tube was continued for gastrointestinal decompression, while active anti-infection and fluid rehydration support were used to prevent septic shock. Time is of the essence, and early esophageal rupture requires immediate surgery**. Director Chen Jicai instructed Dr. Li Yongfeng to quickly improve the preoperative preparations for the emergency department, and immediately returned to the hospital from home, leading the medical team to activate the green channel and launch a life-and-death rescue operation.
Director Chen Jicai combined with intraoperative gastroscopy to accurately locate the rupture site above the esophageal cardia junction, and quickly performed suture repair of the rupture. At the same time, the anesthesia team closely monitors the patient's vital signs to ensure the safety of the surgical process.
The thoracic surgery team is undergoing emergency surgery.
In the end, this dangerous emergency surgery was successfully completed within 8 hours of esophageal rupture, and the thoracic surgery team successfully repaired the patient's esophageal rupture and stabilized the patient's vital signs. After the operation, after the careful care and nutritional support of the intensive care department and the thoracic surgery medical team, he recovered well, and did not have severe pneumonia, empyema and esophageal rupture and leakage, etc., and has now resumed normal diet and was successfully discharged.
Reminder: This disease is more common in men who are most likely to be affected by drinking alcohol and vomiting.
Spontaneous esophageal rupture refers to a sudden increase in pressure in the esophageal lumen due to various causes, resulting in a full-thickness longitudinal dehiscence of the esophageal wall adjacent to the diaphragm. It usually occurs after drinking alcohol and vomiting. The incidence of this disease is low, more common in men aged 30-60 years, and it is one of the rare fatal emergencies in thoracic surgery, but its case fatality rate is as high as 25% to 100%, and once the disease occurs, the disease progresses rapidly, and the misdiagnosis rate and mortality rate are high.
After esophageal rupture, patients may develop toxic shock and even respiratory failure within a very short period of time due to the continuous influx of infectious toxins into the chest cavity and mediastinum. If the infection focus is not completely removed, it is difficult for the patient's symptoms of infection and poisoning to be improved, and the conservative ** cannot completely remove the infection focus, so the effect is poor. Intrathoracic esophageal rupture and perforation due to severe contamination and obvious local inflammation and edema of the esophagus, esophageal repair should be performed within 12 hours after the rupture and perforation. The common symptoms of esophageal rupture are nausea and vomiting, followed by chest pain, epigastric pain, subcutaneous emphysema, the pain is tearing, and the pain is mostly located in the upper abdomen, retrosternal, biquarters of the ribs, and lower chest. Early diagnosis and prompt surgery for spontaneous esophageal rupture are key to reducing mortality.
Text: Guangzhou** New Flower City Reporter: Zhou Jieying Correspondent: Zha Guanlin Guangzhou** New Flower City Editor: Wu Wanhong.