Henry Reynold, McGillen Patrick, Barry Wesley E, Wecsler Julie S, Knight Brandon, Matsushima Kazuhide, Van Zyl Carin, Crookes Peter
Department of Surgery, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033, United States.
Department of Palliative Medicine, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033, United States.
J Surg Case Rep. 2024 Dec 12;2024(12):rjae765. doi: 10.1093/jscr/rjae765. eCollection 2024 Dec.
Gastric surgery may result in internal herniation of bowel, weeks to years after the initial surgery and can result in rapid onset of death if not promptly treated. We present a case in which a patient with this complication underwent surgery despite his clear refusal of surgery. The patient had a remote history of gastrectomy for malignancy. Several years later, he presented with the feared complication of an internal herniation to a local hospital. The initial surgeon recommended urgent operation to correct this. However, the patient refused. When he became comatose, the surgeon performed surgery, but the patient's condition continued to deteriorate. The surgeon performed further surgery, eventually removing the entire small bowel, leaving nothing connecting the esophagus or effluent from the liver and pancreas. Although this was a fatal situation, he had temporary recovery sufficient to understand the nature of his prognosis and survived several weeks.
胃手术可能在初次手术后数周甚至数年导致肠内疝形成，如果不及时治疗，可能会迅速导致死亡。我们报告一例患者，尽管其明确拒绝手术，但仍接受了针对这种并发症的手术。该患者曾因恶性肿瘤行胃切除术。几年后，他因令人担忧的肠内疝并发症就诊于当地一家医院。最初的外科医生建议紧急手术以纠正此情况。然而，患者拒绝了。当他昏迷后，外科医生实施了手术，但患者的病情仍继续恶化。外科医生又进行了进一步手术，最终切除了整个小肠，导致食管与肝脏和胰腺的流出物之间没有任何连接。尽管这是一种致命情况，但他有短暂的恢复，足以理解其预后的性质，并存活了几周。
