Flores Jose C, López-Herce Jesús, Sola Itziar, Carrillo Angel
Sección de Cuidados Intensivos Pediátricos, Hospital Gregorio Marañón, Madrid, Spain.
Nutrition. 2006 Feb;22(2):209-12. doi: 10.1016/j.nut.2005.08.005.
We describe the case of a 2-mo-old infant who weighed 3.5 kg, had alveolar interstitial pneumopathy on mechanical ventilation, and developed a duodenal perforation due to a 6-Fr polyurethane transpyloric tube.
Abdominal ultrasound showed the tube to be within the intestinal lumen. Due to this diagnostic error, nutrition was administered through the tube and the patient developed severe peritonitis. Laparotomy showed a perforation due to the transpyloric tube at the level of the union of the second and third portions of the duodenum. The perforation was sutured but the patient developed new intestinal perforations with severe progressive intestinal damage, leading to multiorgan failure and death.
If there is a clinical suspicion of intestinal perforation secondary to insertion of a transpyloric tube, the position of the tube must be confirmed by radiographic and echographic techniques. In case of doubt, the tube should be withdrawn and endoscopic or contrast radiographic evaluation must be performed.
我们描述了一名2个月大、体重3.5千克的婴儿病例，该婴儿在机械通气时患有肺泡间质性肺病，并因一根6F聚氨酯经幽门管导致十二指肠穿孔。
腹部超声显示管子位于肠腔内。由于这一诊断错误，通过该管给予营养，患者发展为严重腹膜炎。剖腹手术显示在十二指肠第二和第三部分连接处水平因经幽门管导致穿孔。穿孔进行了缝合，但患者出现新的肠穿孔并伴有严重的进行性肠道损伤，导致多器官功能衰竭和死亡。
如果临床上怀疑经幽门管插入继发肠穿孔，必须通过放射学和超声检查技术确认管子位置。如有疑问，应拔出管子，并进行内镜或造影剂放射学评估。
