食管裂孔疝后胃坏死：一例报告。
Gastric necrosis following a hiatal hernia: A case report.
作者信息
Longchamp Gregoire, Andres Axel, Abbassi Ziad
机构信息
Division of Digestive Surgery, University Hospitals of Geneva, 1205, Geneva, Switzerland.
Division of Digestive Surgery, University Hospitals of Geneva, 1205, Geneva, Switzerland.
出版信息
Int J Surg Case Rep. 2021 Feb;79:108-111. doi: 10.1016/j.ijscr.2020.12.092. Epub 2021 Jan 6.
INTRODUCTION
Gastric volvulus are rare. Complications can be life threatening, including necrosis and perforation. Assessment of mucosal viability is essential, and urgent surgical intervention is mandatory in case of vascular compromise.
PRESENTATION OF CASE
An 72-year-old female known for a paraesophageal hiatal hernia was admitted at our emergency department with acute abdominal pain. Blood count demonstrated leukocytosis and increased C-reactive protein. Abdominal computed tomography showed a mesenteroaxial gastric volvulus. Urgent upper endoscopy revealed mucosal ischemia, which prompted immediate laparotomy with partial gastrectomy, cruroplasty, and Dor fundoplication. Postoperative course was uneventful.
DISCUSSION
Gastric volvulus is initially treated with nasogastric tube decompression, but definitive treatment is achieved surgically. When there is an associated hernia, closing the anatomical defect and fundoplication should be performed. Complication such as necrosis is associated with a high mortality, and requires urgent surgical repair.
CONCLUSION
Gastric volvulus can be life-threatening. Urgent endoscopic or surgical assessment should be conducted to assess mucosal viability.
引言
胃扭转较为罕见。其并发症可能危及生命，包括坏死和穿孔。评估黏膜活力至关重要，一旦出现血管受损，必须紧急进行手术干预。
病例介绍
一名72岁女性，已知患有食管旁裂孔疝，因急性腹痛入住我院急诊科。血常规显示白细胞增多，C反应蛋白升高。腹部计算机断层扫描显示为系膜轴型胃扭转。紧急上消化道内镜检查显示黏膜缺血，这促使立即进行剖腹手术，行部分胃切除术、膈肌修补术和Dor胃底折叠术。术后病程顺利。
讨论
胃扭转最初采用鼻胃管减压治疗，但最终治疗需通过手术实现。当存在相关疝时，应进行解剖缺陷闭合和胃底折叠术。坏死等并发症与高死亡率相关，需要紧急手术修复。
结论
胃扭转可能危及生命。应进行紧急内镜或手术评估以评估黏膜活力。
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