Zodda David, Haley Meta, Sayegh Rocky
Hackensack University Medical Center, Hackensack, New Jersey.
J Emerg Med. 2017 Jul;53(1):e15-e17. doi: 10.1016/j.jemermed.2017.02.007. Epub 2017 Apr 10.
Emergency departments (EDs) are gateways for patients presenting after minor surgical procedures, particularly shockwave lithotripsy. Complications include renal and extrarenal tissue injuries, with the latter having potentially serious consequences if not detected early.
We describe a 70-year-old male presenting to the ED for syncope. The patient underwent shockwave lithotripsy (SWL) for left kidney stones 1 day prior. Upon initial evaluation, the patient had normal vital signs and a normal physical examination, without complaints of abdominal pain. Close observation and regular patient re-evaluation led to the diagnosis of life-threatening injuries that included splenic rupture. Although this is a rare complication of SWL, with only eight published cases found in the literature, the patient's initial presentation of syncope without complaints of abdominal pain presented a unique diagnostic challenge. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be knowledgeable of the pre-existing conditions linked to higher rates of complications after shockwave lithotripsy and be able to identify and manage these potentially life-threatening complications.
急诊科是接受小手术后患者的就诊通道，尤其是体外冲击波碎石术后的患者。并发症包括肾脏和肾外组织损伤，如果不及早发现，后者可能会产生严重后果。
我们描述了一名70岁男性因晕厥就诊于急诊科。该患者1天前因左肾结石接受了体外冲击波碎石术（SWL）。初步评估时，患者生命体征正常，体格检查正常，无腹痛主诉。密切观察和定期对患者进行重新评估后，诊断出危及生命的损伤，包括脾破裂。虽然这是体外冲击波碎石术的一种罕见并发症，文献中仅发现8例已发表的病例，但该患者最初表现为晕厥且无腹痛主诉，这带来了独特的诊断挑战。急诊科医生为何应了解这一点？：急诊科医生应了解与体外冲击波碎石术后并发症发生率较高相关的既往疾病，并能够识别和处理这些潜在的危及生命的并发症。
