鼻胃管插管致肺穿孔1例

鼻胃管指从鼻腔经食管留置于胃的导管,临床常用于给药、胃肠减压或营养支持等[1]。鼻胃管插管过程中,除常见鼻咽黏膜损伤及误入气管外,可能会发生一些少见严重并发症,如咽壁穿孔、胃穿孔、肺穿孔等[2-4]。本文报道1例鼻胃管插管致肺穿孔案例,并组织专家分析讨论如下。1病历摘要患者,男,86岁,因“运动障碍伴认知功能下降1月余”于2020年1月23日入院。

Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons.Sometimes too much reliance is put on investigations that can lead to a misdiagnosis.This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase,which led to an assumed diagnosis of pancreatitis.She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis,with no evidence of pancreatitis.Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

Small bowel perforation secondary to metastatic lung cancer with emphasis on the administration of erlotinib: a case report

Small bowel metastasis from primary lung cancer is rare. Once occurs, the metastasis may cause life-threatening complications, such as bowel perforation, obstruction and bleeding. We reported an 83-year old man who presented with small bowel perforation secondary to metastatic lung cancer after being treated with erlotinib for 2 weeks. We propose that the use of erlotinib may be associated with the small bowel perforation and precautions should be taken by clinicians in initiating edotinib for primary lung cancer when there is bowel metastasis.

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end-colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigationof even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

父亲的叹息

父亲去世那年,我正好考上大学。他得的是肺气肿,也有人说是肺穿孔,但到底是什么病,谁也没搞清楚。父亲跑了一趟北京官厅水库的医院,没几天就回来了。他说,那地方贵巴巴的,咱住不起。父亲批发了些青霉素,每天在家里输液。开始,是村里的医生给他扎针,时间久了,医生推托着,不愿来。没办法,有一次,父亲对我说,来,你给我扎。我说,我不会。父亲说,没事。

新词

蜗牛男孩江西省瑞金市壬田镇柏坑小学五年级学生骆田森10年前患上小儿麻痹症。父母带着小田森四处治疗,花了20多万元也不见好转。2013年,小田森又突发肺穿孔,家里欠下一大笔外债,为了还债,父母外出打工。上学后,72岁的奶奶每天都会接送他上下学。放学时,奶奶把田森背下楼梯,扶上轮椅,推着他返回一公里外的家中。