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结肠胸膜瘘引起的脓胸:一例报告。

Empyema caused by a colopleural fistula: A case report.

作者信息

Lian Rui, Zhang Guochao, Zhang Guoqiang

机构信息

Department of Emergency Medicine Departmentof General Surgery, China-Japan Friendship Hospital, Beijing, China.

出版信息

Medicine (Baltimore). 2017 Sep;96(39):e8165. doi: 10.1097/MD.0000000000008165.

Abstract

RATINALE

Empyema is a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. An empyema caused by colo-pleural fistula is a rare but potentially life-threatening condition.

PATIENT CONCERNS

We describe a case of 42-year-old man was brought to our Emergency Department for chest pain with dyspnea and fever.

DIAGNOSES

The final diagnoses are empyema caused by colo-pleural fistula and colon cancer.

INTERVENTIONS

The patient underwent laparotomy surgery, during which a tumor was found in the splenic flexure of the descending colon. The tumor penetrated the colonic serosa and invaded the left side of the diaphragm. A left hemicolectomy was performed.

OUTCOMES

After the operation, the patient recovered smoothly and was discharged on postoperative day 14. It's been over 3 years now, CT and colonoscopy assessments show no recurrence or metastasis.

LESSONS

This case serves as a reminder to test for pathogens in patients with an unexplained empyema. If normal intestinal bacteria are detected, the empyema may be derived from intestinal disease. In addition, an abdominal examination should be performed in patients with an empyema of unknown origin.

摘要

理论依据

脓胸是一种脓液积聚在肺与胸壁内表面之间区域的病症。由结肠胸膜瘘引起的脓胸是一种罕见但可能危及生命的病症。

患者情况

我们描述了一例42岁男性因胸痛伴呼吸困难和发热被送至我院急诊科的病例。

诊断结果

最终诊断为结肠胸膜瘘引起的脓胸和结肠癌。

干预措施

患者接受了剖腹手术,术中在降结肠脾曲发现一个肿瘤。肿瘤穿透结肠浆膜并侵犯膈肌左侧。进行了左半结肠切除术。

治疗结果

术后患者恢复顺利,术后第14天出院。现已过去3年多,CT和结肠镜检查评估显示无复发或转移。

经验教训

该病例提醒我们,对于不明原因脓胸患者要进行病原体检测。如果检测到正常肠道细菌,脓胸可能源于肠道疾病。此外,对于不明原因脓胸患者应进行腹部检查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/de53/5626310/af7b7ecc4fc8/medi-96-e8165-g001.jpg

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