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[Intensive Care Medicine重症医学影像]:错位的鼻十二指肠喂养管
2017年02月27日 临床影像, 临床话题 评论数 2

IMAGING IN INTENSIVE CARE MEDICINE

A nasoenteral feeding tube barking up the wrong tree

Hafiz Abdul Moiz Fakih, Salim Daouk, Martin Runnstrom, et al.

Intensive Care Med

DOI 10.1007/s00134-017-4686-3

A 58-year-old woman with multiple co-morbidities, including a history of kidney and pancreas transplant, was admitted to the intensive care unit for management of septic shock. She had a prolonged course and had a small-bore nasoduodenal feeding tube placed under electromagnetic sensing device guidance. She soon developed abdominal distention with absence of bowel sounds followed by hemodynamic compromise. An abdominal X-ray (Fig. 1) revealed an abnormal air pattern in the right upper quadrant (blue star) and the feeding tube (yellow arrow). A computerized tomography scan of the abdomen (Fig. 2) showed the feeding tube (yellow arrow) perforating through the intestine (blue arrow) with air in the right retroperitoneal space (green star), as well as oral contrast leakage (red arrow) into the right retroperitoneal space (Fig. 3). She was emergently taken to the operating room for drainage of the retroperitoneal fluid collection and removal of the feeding tube. She continued to decline after surgery and eventually passed away after the family decided to withdraw care.

一名58岁女性患者罹患多种基础疾病,包括肾脏及胰腺移植。患者因感染性休克收入ICU。 因病情迁延,在电磁感知装置引导下留置细鼻十二指肠喂养管。不久,患者出现腹胀,肠鸣音消失,随后血流动力学不稳定。腹部X片(图1)显示右上腹异常气体影像(蓝色星号)及喂养管(黄色箭头)。腹部CT扫描(图2)显示喂养管(黄色箭头)造成肠穿孔(蓝色箭头),伴右侧后腹膜积气(绿色星号),同时口服造影剂(红色箭头)渗漏入右侧腹膜后间隙(图3)。患者被紧急送入手术室接受腹膜后积液引流,并拔除喂养管。手术后患者病情持续恶化,家属决定放弃治疗后患者最终去世。

目前有 2 条留言 其中:访客:2 条, 博主:0 条

  1. bruse975011 : 2017年02月28日22:38:18  -49楼

    在大陆,又是纠纷!

  2. lengdao1973 : 2017年02月27日11:34:22  -48楼

    当初要多大的力量下这个空肠管!

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