Gryboś Szymon, Karaffová Viera, Klapačová Katarina
Department of Pediatric Surgery, Childrens Faculty Hospital in Košice, Tr. SNP 1, 04011 Košice, Slovakia.
Department of Morphological Disciplines, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 04181 Košice, Slovakia.
Pediatr Rep. 2024 Aug 15;16(3):717-723. doi: 10.3390/pediatric16030060.
In this case report, we described a rare complication-lung torsion after esophageal atresia repair in a newborn. Torsion of the lung is a critical condition in which either the entire lung or a lung lobe twists, leading to occlusion of blood vessels and airways. The patient's clinical condition was poor after the primary operation. An emergency thoracotomy showed 180° torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion, perioperatively, the lung was gradually reperfused and had a normal appearance. After surgery, the patient was unstable, which culminated in a fatal end (bradycardia, reperfusion injury). Immediate intervention can preserve the affected lung or lung lobe. However, pulmonary torsion typically has a poor prognosis due to misdiagnosis and delayed treatment. Additionally, diagnosis in the neonatal period is even more challenging because the clinical symptoms are nonspecific. In any case, the question is whether detorsion is the right solution or whether a segmentectomy is necessary.
在本病例报告中，我们描述了一名新生儿食管闭锁修复术后罕见的并发症——肺扭转。肺扭转是一种危急情况，即整个肺或肺叶发生扭转，导致血管和气道阻塞。初次手术后患者的临床状况较差。急诊开胸手术显示右上叶（RUL）和右中叶（RML）发生了180°扭转。扭转解除后，术中肺逐渐重新灌注且外观正常。术后患者情况不稳定，最终导致致命结局（心动过缓、再灌注损伤）。立即干预可保住受累的肺或肺叶。然而，由于误诊和治疗延误，肺扭转的预后通常较差。此外，新生儿期的诊断更具挑战性，因为临床症状不具有特异性。无论如何，问题在于扭转解除是否是正确的解决办法，或者是否有必要进行肺段切除术。
