Sleiwah A, Thomas G, Crawford I, Stanek A
Department of Plastic Surgery, NIMDTA, Belfast, UK.
Department of General Surgery, Western Trust, Enniskillen, UK.
BMJ Case Rep. 2017 Mar 8;2017:bcr2016217708. doi: 10.1136/bcr-2016-217708.
A woman aged 67 years attended the emergency department with acute abdominal and back pain of 1-day duration with associated vomiting. The patient had multiorgan failure. Resuscitation was started with intravenous fluids and vasopressors. An abdominal CT scan was completed which confirmed the diagnosis of acute gastric volvulus. The patient was successfully resuscitated from a cardiorespiratory arrest during transfer to the operating theatre. The patient subsequently underwent a total gastrectomy with stapling of the oesophageal and duodenal stumps. The abdomen was packed and left open as a laparostomy with a planned relook 48 hours later was to be performed. Unfortunately, the patient continued to deteriorate postoperatively in the intensive care unit despite maximum organ support for multiorgan failure. A decision was made to withdraw treatment and the patient died 10 hours postoperative. This case illustrates the presentation of acute gastric volvulus at a late stage and the high mortality rate associated with it.
一名67岁女性因持续1天的急性腹痛和背痛并伴有呕吐到急诊科就诊。该患者出现多器官功能衰竭。开始通过静脉输液和血管加压药进行复苏。完成了腹部CT扫描，确诊为急性胃扭转。在转往手术室的过程中，患者成功从心肺骤停中复苏过来。患者随后接受了全胃切除术，并用吻合器吻合食管和十二指肠残端。腹部进行了填塞并敞开作为剖腹造口术，计划48小时后再次探查。不幸的是，尽管对多器官功能衰竭给予了最大程度的器官支持，但患者在重症监护病房术后仍持续恶化。决定停止治疗，患者术后10小时死亡。该病例说明了急性胃扭转的晚期表现及其相关的高死亡率。
