Takaki Shunsuke, Yamaguchi Osamu, Morimura Naoto, Goto Takahisa
Yokohama City University Hospital, Department of Anesthesiology and Critical Care Medicine, 3-9 Fukuura, Kanazawaku, Yokohama 236-0004, Japan.
Yokohama City University Hospital, Department of Anesthesiology and Critical Care Medicine, 3-9 Fukuura, Kanazawaku, Yokohama 236-0004, Japan.
Int J Surg Case Rep. 2015;16:112-5. doi: 10.1016/j.ijscr.2015.09.019. Epub 2015 Sep 25.
Patients with oral penetration injuries require a systematic physical examination. These patients should be managed by a multidisciplinary medical team. Airway management, operative procedures, and transfusion needs of the patient with an oral penetration injury should be discussed before surgery.
A 63-year-old man with a history of recurrent hepatic duct cancer attempted suicide by advancing an intravenous pole through his mouth, neck, and thorax, ultimately penetrating into the right retroperitoneal space. A multidisciplinary team assembled by code blue emergently treated the patient, initially with fiberoptic intubation. The injured right lower lung was resected under one lung ventilation via a double lumen tube after tracheostomy. Fortunately, the pole did not injure any other organs or major vessels. Despite successful removal of the pole after lung resection, the patient died 14 days postoperatively due to his primary hepatic duct cancer.
We highlight the need for a multidisciplinary approach to this patient's management and discuss particular aspects of airway and transfusion management.
A systematic and multidisciplinary approach allowed successful removal of the drip pole and stabilization of the patient's respiratory and hemodynamic status.
口腔贯通伤患者需要进行系统的体格检查。这些患者应由多学科医疗团队进行管理。口腔贯通伤患者的气道管理、手术操作及输血需求应在手术前进行讨论。
一名63岁有复发性肝管癌病史的男性,通过将静脉输液杆经口腔、颈部和胸部推进,试图自杀,最终穿透至右腹膜后间隙。由紧急情况代码召集的多学科团队对该患者进行了紧急治疗,最初采用纤维支气管镜插管。气管切开术后,通过双腔管在单肺通气下切除了受伤的右下肺。幸运的是,输液杆未损伤任何其他器官或大血管。尽管肺切除术后成功取出了输液杆,但患者术后14天因原发性肝管癌死亡。
我们强调对该患者的管理需要采用多学科方法,并讨论气道和输血管理的具体方面。
系统的多学科方法使输液杆得以成功取出,并稳定了患者的呼吸和血流动力学状态。