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穿透性腹部创伤背景下的渗出-缩窄性结核性心包炎

Effusive-constrictive tuberculous pericarditis in the setting of penetrating abdominal trauma.

作者信息

Meytes Vadim, Docimo Salvatore, Elkowitz David, Kopatsis Anthony

机构信息

Department of Surgery, NYU Lutheran Medical Center, Brooklyn, New York, USA.

Department of Minimally Invasive & Bariatric Surgery, Penn State Hershey Medical Center, Hershey, PA.

出版信息

BMJ Case Rep. 2015 Aug 26;2015:bcr2015211575. doi: 10.1136/bcr-2015-211575.

Abstract

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.

摘要

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。

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