Weir A, Bartlett E, Bowling K, Andrews S, Guest T
Department of Anaesthesia and Intensive Care Medicine Torbay Hospital Torquay UK.
Department of Surgery Torbay Hospital Torquay UK.
Anaesth Rep. 2019 Apr 11;7(1):26-28. doi: 10.1002/anr3.12008. eCollection 2019 Jan-Jun.
We report a case of sudden cardiovascular collapse several weeks following surgical repair of a traumatic diaphragmatic hernia. The patient presented with features of circulatory shock without a clear diagnosis, therefore an urgent computed tomography scan of the chest and abdomen was undertaken, which revealed a pericardial effusion with evidence of cardiac tamponade. Ultrasound-guided needle pericardiocentesis with aspiration of blood from the pericardial sac in the Emergency Department provided an immediate response and her cardiac output improved. On review of the imaging, it is likely a surgically-placed permanent metallic fixation device, sitting near the pericardium, caused bleeding into the pericardial sac due to local trauma as a delayed postoperative complication.
我们报告一例创伤性膈疝手术修复几周后出现的突发性心血管衰竭病例。患者表现为循环性休克特征,但诊断不明确,因此紧急进行了胸部和腹部计算机断层扫描,结果显示有心包积液及心脏压塞的证据。在急诊科,超声引导下经皮心包穿刺术从心包腔内抽出积血后,患者立即有了反应,心输出量得到改善。回顾影像学检查,很可能是手术置入的永久性金属固定装置靠近心包,作为术后延迟并发症因局部创伤导致心包腔内出血。