Meng Muzi, Riera Gonzalez Cesar, Teklu Yonas, Mosquera Zavaleta Jorge, Singh Ajit
School of Medicine, American University of the Caribbean, Cupecoy, SXM.
General Surgery, BronxCare Health System, Bronx, USA.
Cureus. 2024 Feb 12;16(2):e54057. doi: 10.7759/cureus.54057. eCollection 2024 Feb.
The efficacy of intraoperative esophagogastroduodenoscopy (EGD) in visualizing a patient's small bowel interior to detect injuries or lesions, or conduct a leak test post-bowel anastomosis, makes it a preferred option among surgeons. However, it is not always available, can carry a risk of morbidity and mortality, or can prolong operative time if not performed by a proficient team. A 21-year-old male patient came to the emergency department with four gunshot wounds to his abdomen, with two on either side of the abdomen. Exploratory laparotomy was performed and through and through injuries were identified in the small bowel and at the junction of the third/fourth portion of the duodenum. It was challenging to gather the patient's past medical history, particularly gastrointestinal bleeding history, due to the underlying medical condition. However, the patient had experienced a retroperitoneal bowel injury in the setting of duodenal hematoma that was not immediately identified at first glance. In this context, intraoperative endoscopy could be a significant adjunct to detect retroperitoneal bowel injury if rapidly available and in a controlled scenario. Moreover, the advantages of intraoperative EGD increase with positive collaboration between a general surgeon and a gastroenterologist.
术中食管胃十二指肠镜检查（EGD）在观察患者小肠内部以检测损伤或病变，或在肠吻合术后进行渗漏试验方面的有效性，使其成为外科医生的首选。然而，它并非总是可用，可能存在发病和死亡风险，如果不是由熟练的团队进行操作，还可能延长手术时间。一名21岁男性患者因腹部四处枪伤来到急诊科，腹部两侧各有两处枪伤。进行了剖腹探查术，发现小肠和十二指肠第三/四段交界处有贯通伤。由于患者的基础病情，收集其既往病史，尤其是胃肠道出血史具有挑战性。然而，患者曾在十二指肠血肿情况下发生过腹膜后肠损伤，乍一看并未立即被发现。在这种情况下，如果能迅速获得且在可控的情况下，术中内镜检查可能是检测腹膜后肠损伤的重要辅助手段。此外，普通外科医生和胃肠病学家之间的积极协作会增加术中EGD的优势。
