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疑似脑膜炎球菌败血症合并急性呼吸窘迫综合征患者因长时间插管导致气管食管瘘:一例报告

Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report.

作者信息

Rana Ramesh, Sapkota Rikesh, Shakya Binesh, Gautam Samir

机构信息

Department of Internal Medicine, Gautam Buddha Community Heart Hospital, Butwal, Nepal.

Department of Anaesthesiology, Gautam Buddha Community Heart Hospital, Butwal, Nepal.

出版信息

JNMA J Nepal Med Assoc. 2018 Nov-Dec;56(214):980-982. doi: 10.31729/jnma.3890.

Abstract

Tracheoesophageal fistula is an abnormal communication between trachea and esophagus. Benign acquired types are rare with the incidence of less than 1%. Prolonged endotracheal intubation remains the most common cause. We are reporting a 28 years old female patient presented with chief complaint of a cough after each meal intake in the outpatient clinic. She had a recent history of admission in the intensive care unit with prolonged intubation (11 days). Her general physical examination, laboratory examination, and chest x-ray were normal. Esophagogastroscopy was performed and revealed communication between upper esophagus and trachea approximately at 14-17cm embedded in longitudinal mucosal folds of the esophagus. She was referred to the higher center for surgical repair. Though, a rare complication, high suspicion is necessary to accurately diagnose the disease in a patient with the history of prolonged intubation. Keywords: case report; endotracheal intubation; mechanical ventilation; tracheoesophageal fistula.

摘要

气管食管瘘是气管与食管之间的异常通道。良性后天性类型较为罕见,发病率低于1%。长时间气管插管仍然是最常见的原因。我们报告一名28岁女性患者,在门诊以每餐进食后咳嗽为主诉就诊。她近期有在重症监护病房长时间插管(11天)的病史。她的全身体格检查、实验室检查和胸部X线检查均正常。进行了食管胃镜检查,发现食管上段与气管之间在距食管起始部约14 - 17cm处相通,包埋于食管纵行黏膜皱襞内。她被转诊至上级中心进行手术修复。虽然这是一种罕见的并发症,但对于有长时间插管病史的患者,高度怀疑对于准确诊断该病很有必要。关键词:病例报告;气管插管;机械通气;气管食管瘘

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/43e4/8827602/b2fb9cf657a4/JNMA-56-214-980-g1.jpg

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