Oshiro Masaya, Kanda Hirotsugu, Oshiro Akane, Kure Kenta, Kanao-Kanda Megumi, Kamiya Hiroyuki, Kunisawa Takayuki
Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
JA Clin Rep. 2018 Jun 26;4(1):52. doi: 10.1186/s40981-018-0189-7.
Though several cases of upper gastrointestinal tract injury caused by transesophageal echocardiography (TEE) have been reported, gastric perforation is very rare. Herein, we report the case of TEE-associated gastric perforation that was successfully treated conservatively.
An 82-year-old man underwent mitral valve repair. Postoperative esophagogastroduodenoscopy and computed tomography revealed gastric perforation. Surgical treatment was initially considered, but conservative management was selected to avoid increasing operative stress, to minimize the need for total gastrectomy (including the lower esophagus), and to minimize the risk of a potential intraperitoneal infection spreading to the thoracic cavity.
Conservative management of gastric perforation can be successful even when the perforation is recognized later than 12 h following the event, provided that there are no abdominal symptoms and no signs of peritoneal effusion or sepsis. Our experience suggests that conservative management is a feasible option for treating TEE-associated gastric perforation in appropriately selected cases.
尽管已有经食管超声心动图（TEE）导致上消化道损伤的多例报道，但胃穿孔非常罕见。在此，我们报告一例经保守治疗成功的TEE相关性胃穿孔病例。
一名82岁男性接受二尖瓣修复术。术后食管胃十二指肠镜检查和计算机断层扫描显示胃穿孔。最初考虑手术治疗，但选择了保守治疗，以避免增加手术应激，尽量减少全胃切除术（包括食管下段）的必要性，并将潜在的腹腔感染扩散至胸腔的风险降至最低。
即使胃穿孔在事件发生后12小时以上才被发现，只要没有腹部症状且没有腹腔积液或脓毒症迹象，保守治疗胃穿孔也可能成功。我们的经验表明，在适当选择的病例中，保守治疗是治疗TEE相关性胃穿孔的可行选择。
