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钝性腹部创伤中漏诊的胃损伤:病例报告并文献复习

Missed Gastric Injuries in Blunt Abdominal Trauma: Case report with review of literature.

作者信息

Naiem Ahmed A, Taqi Kadhim M, Al-Kendi Badriya H, Al-Qadhi Hani

机构信息

General Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman.

Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.

出版信息

Sultan Qaboos Univ Med J. 2016 Nov;16(4):e508-e510. doi: 10.18295/squmj.2016.16.04.019. Epub 2016 Nov 30.

Abstract

Hollow viscus injuries of the digestive tract are an uncommon occurrence in blunt abdominal trauma. We report a 39-year-old male who was hit by a vehicle as a pedestrian and admitted to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015. He underwent an exploratory laparotomy which revealed injuries to the distal stomach, liver and descending colon. Postoperatively, the patient was febrile, tachycardic and hypotensive. Abdominal examination revealed distention and tenderness. The next day, a repeat laparotomy identified a gastric injury which had not been diagnosed during the initial laparotomy. Although the defect was repaired, the patient subsequently died as a result of multiorgan failure. Missed gastric injuries are rare and are associated with a grave prognosis, particularly for trauma patients. Delays in diagnosis, in addition to associated injuries, contribute to a high mortality rate.

摘要

消化道中空脏器损伤在钝性腹部创伤中并不常见。我们报告一例39岁男性,2015年作为行人被车辆撞击后,被送往阿曼马斯喀特的苏丹卡布斯大学医院。他接受了剖腹探查术,结果显示胃远端、肝脏和降结肠受伤。术后,患者发热、心动过速且血压降低。腹部检查发现腹胀和压痛。第二天,再次剖腹探查发现了一处在初次剖腹探查时未被诊断出的胃损伤。尽管缺损得到了修复,但患者随后因多器官功能衰竭死亡。漏诊的胃损伤很罕见,且预后严重,尤其是对于创伤患者。除了合并伤外,诊断延误导致死亡率很高。

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