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关于一例尺动脉创伤后动脉瘤漏诊的病例。职业责任方面的法医学问题。

About a case of missed diagnosis of a post-traumatic aneurysm in the ulnar artery. Medical-legal aspects in respect to the professional liability.

作者信息

Prezioso Virginia, Mangiulli Tatiana, Bolino Giorgio, Sciacca Vincenzo

出版信息

Ann Ital Chir. 2014 Mar-Apr;85(2):171-6.

Abstract

Compartment syndrome of the left hand from a late diagnosed post-traumatic ulnar artery pseudoaneurysm. We report the case of 27 years old boy with a tipping and cutting wound on his left wrist, generating an ulnar artery pseudoaneurysm, that was late diagnosed, and therefore complicated by a compartment syndrome in the wrist. Immediately after the trauma the subject went to the emergency room where the severity of the injury was undestimated; in fact, it was sutured and medicated, without further investigation. When he went to the same hospital for the second time, symptoms (pulsatile mass, redness and irritation of the skin) were interpreted as an infectious process and treated in an incongruous way. Then, when he went to another hospital in which imaging studies (ultrasound) were performed, the pseudo- aneurysm of the ulnar artery was diagnosed and surgically treated. The delay in diagnosis led to a compartment syndrome that is still appreciable as a sensory-motor deficit of the hand, especially of the fourth and fifth finger. This pseudo- aneurysm complication and its debilitating outcomes are known in literature, so the diagnostic delay makes the sanitary staff guilty of the suffered damage.

摘要

迟发性创伤性尺动脉假性动脉瘤导致左手骨筋膜室综合征。我们报告一例27岁男性,其左手腕有刺伤和切割伤,形成尺动脉假性动脉瘤,诊断延迟,进而并发腕部骨筋膜室综合征。受伤后该患者立即前往急诊室,当时损伤的严重程度被低估;实际上,伤口仅进行了缝合和药物治疗,未作进一步检查。当他第二次前往同一家医院时,症状(搏动性肿块、皮肤发红和刺激)被误诊为感染性病变并接受了不恰当的治疗。随后,当他前往另一家医院并进行影像学检查(超声)时,尺动脉假性动脉瘤得以诊断并接受了手术治疗。诊断延迟导致了骨筋膜室综合征,目前手部仍存在明显的感觉运动功能障碍,尤其是第四和第五指。这种假性动脉瘤并发症及其致残后果在文献中已有记载,因此诊断延迟使医护人员对所造成的损害负有责任。

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