Okeny Paul K, Abbassi Omar, Warsi Ali
Surgery and Critical care, Furness General Hospital, Barrow-in-Furness, UK.
Surgery, Gulu Regional Referral Hospital, Gulu, Uganda.
BMJ Case Rep. 2018 May 15;2018:bcr-2017-223060. doi: 10.1136/bcr-2017-223060.
A 42-year-old Caucasian woman presented to the emergency department with severe upper abdominal pain and vomiting. Clinically, she was septic, and abdominal examination suggested peritonitis. Following immediate resuscitation, the patient was stabilised and underwent urgent contrast-enhanced CT of the abdomen and pelvis. This revealed a mesenteroaxial gastric volvulus with traction on the mesentery and a small volume of free fluid. She underwent laparotomy revealing gangrenous gastric fundus perforation complicated by persistent intraoperative hypotension. This mandated a damage-control approach for the patient's safety entailing a limited-sleeve gastrectomy and laparostomy formation. Stabilisation in the intensive care unit allowed for a safer return to the operating room. On second look 24 hours later, previously ischaemic non-viable-looking portions of the stomach had recovered their blood supply. The patient was discharged 31 days postoperatively after recovering from the operations, postoperative wound infections and pleural effusions.
一名42岁的白种女性因严重上腹部疼痛和呕吐被送往急诊科。临床上，她出现了脓毒症，腹部检查提示腹膜炎。在立即进行复苏后，患者病情稳定，并接受了腹部和盆腔的紧急增强CT检查。结果显示为系膜轴性胃扭转，伴有肠系膜受牵拉以及少量游离液体。她接受了剖腹手术，术中发现胃底坏疽穿孔，并伴有术中持续性低血压。为了患者安全，采取了损伤控制策略，包括实施有限袖状胃切除术和造口术。在重症监护病房病情稳定后，患者得以更安全地返回手术室。24小时后再次查看时，之前看似缺血无活力的胃部分恢复了血供。患者在术后从手术、术后伤口感染和胸腔积液中恢复后，于术后31天出院。
