Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia.
BMJ Case Rep. 2023 Jan 24;16(1):e252542. doi: 10.1136/bcr-2022-252542.
A male in his 50s arrived by ambulance at a regional Australian hospital after being pinned by a buffalo against a fence by the chest and abdomen. Primary and secondary surveys identified an open fibula fracture and superficial abrasions. CT trauma series identified retropharyngeal free gas extending to the right carotid sheath. Flexible nasoendoscopy revealed a normal upper airway and no site of perforation. Oesophagoscopy and gastroscopy were completed to evaluate for a site of free gas leakage. A hypopharyngeal tear was identified 15 cm from the incisors at the cricopharyngeal sphincter. A gastrograffin swallow was completed which showed no leak. The decision was made to manage the patient conservatively with intravenous dexamethasone and intravenous ceftriaxone/metronidazole for antibiotic prophylaxis. The patient had his diet gradually upgraded and was discharged home 4 days later with oral amoxicillin and clavulanic acid.
一名 50 多岁的男性被水牛抵住胸部和腹部，夹在栅栏上后，由救护车送到澳大利亚一家地区医院。进行了初步和二次检查，发现开放性腓骨骨折和浅表擦伤。CT 创伤系列检查发现咽后游离气体延伸至右侧颈动脉鞘。软性鼻内镜检查显示上呼吸道正常，无穿孔部位。进行食管镜和胃镜检查以评估游离气体泄漏部位。在会厌的环状软骨括约肌处，距切牙 15 厘米处发现下咽裂伤。完成胃造影吞咽检查，未见泄漏。决定对患者进行保守治疗，给予静脉注射地塞米松和头孢曲松/甲硝唑预防抗生素。患者逐渐升级饮食，4 天后出院，口服阿莫西林克拉维酸钾。
