Meytes Vadim, Docimo Salvatore, Elkowitz David, Kopatsis Anthony
Department of Surgery, NYU Lutheran Medical Center, Brooklyn, New York, USA.
Department of Minimally Invasive & Bariatric Surgery, Penn State Hershey Medical Center, Hershey, PA.
BMJ Case Rep. 2015 Aug 26;2015:bcr2015211575. doi: 10.1136/bcr-2015-211575.
Tuberculous pericarditis is rare in developed nations and is most commonly associated with effusive-constrictive pericarditis. We present the case of a 33-year-old man with a self-inflicted mid-abdominal stab wound. The patient underwent an exploratory laparotomy, revealing a grade IV pancreatic transection and injuries to the portal vein, right renal vein, inferior vena cava and the superior mesenteric vein. Repair of the vessels was performed and a pancreaticojejunostomy with a gastrojejunostomy was created for the pancreatic injury. The patient's hospital course was complicated by tuberculous effusive-constrictive pericarditis requiring emergent median sternotomy with opening of the pericardial sac and eventual expiration. The final cultures from the pericardial fluid demonstrated tuberculosis.
结核性心包炎在发达国家较为罕见,最常与渗出性缩窄性心包炎相关。我们报告一例33岁男性自伤性腹部刺伤病例。患者接受了剖腹探查术,发现IV级胰腺横断伤以及门静脉、右肾静脉、下腔静脉和肠系膜上静脉损伤。进行了血管修复,并针对胰腺损伤实施了胰空肠吻合术和胃空肠吻合术。患者的住院过程因结核性渗出性缩窄性心包炎而复杂化,需要紧急正中胸骨切开术打开心包腔,最终患者死亡。心包液的最终培养结果显示为结核。