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[气肿性胃炎作为动脉缩窄切除术后非闭塞性肠系膜缺血的一种表现]

[Emphysematous gastritis as a manifestation of non-occlusive mesenteric ischemia after coartectomy].

作者信息

Quiñonez-López Deyanira, Gutiérrez-Cortés Carolina, Lince-Rivera Catalina, Zuluaga-Orrego César A, Giovanny-Ríos Edgar

机构信息

Unidad de Cuidado Intensivo Pediátrico, Hospital Universitario San Ignacio, Cundinamarca, Bogotá D.C., Colombia.

Servicio de Pediatría, Hospital Universitario San Ignacio, Cundinamarca, Bogotá D.C., Colombia.

出版信息

Arch Cardiol Mex. 2020 Nov 4;91(2):215-220. doi: 10.24875/ACM.20000182.

Abstract

Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.

摘要

对患有主动脉病变的患者进行心血管手术的主要干预措施可能会导致手术部位以外的器官灌注受损,胃肠道是对血流动力学变化最敏感的器官之一,尤其是在发病率和死亡率风险较高的极端年龄组中。本文报告了一名患有特纳综合征的幼儿病例,该患儿接受了主动脉缩窄合并主动脉弓发育不全的矫正手术,术后出现了伴有全身功能障碍的气肿性胃炎,这一过程因体外循环后心输出量低和早期泌尿道感染而加重,所有这些都被解释为非闭塞性肠系膜缺血综合征的一部分。其早期诊断使得能够迅速采取干预措施,包括肠外营养支持、抑酸、广谱抗生素治疗和严格的影像学随访,症状得以完全缓解,且无短期并发症。该病例表明,识别内脏缺血的危险因素、高度的临床怀疑和谨慎的医疗管理,对于这种死亡率高且儿科人群中报道病例极少的疾病,可以带来良好的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed98/8295857/85734d33e6a4/ACM-91-215-g001.jpg

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