Retrosternal Gastric Tube Ulcer Complicated by Pneumopericardium and Pneumomediastinum: A Case Report

食道重建後之胃潰瘍引發心包膜及縱膈氣腫的病例報告

何世偉(Sai-Wai Ho) ； 吳肇鑫(Chao-Hsin Wu) ； 陳永福(Ying-Hock Teng)

《中華民國急救加護醫學會雜誌》 19卷2期 (2008/06) Pp. 60-64

https://doi.org/10.30018/JECCM.200806.0003

摘要

因胃作食道重建後的胃潰瘍引發心包膜及縱膈氣腫的個案並不常見，在此報告一位曾接受利用胃作食道重建的73歲男性個案，其主訴是胸痛及呼吸困難，胸部X光檢查呈現縱膈氣腫，而電腦斷層則診斷為心包膜及縱膈氣腫，隨後立即安排緊急手術包括把重建的胃摘除、十二指腸造口術、心包膜部分切除及胸管放置，一方面進行修補工作，另一方面則是避免致命性的併發症。手術發現及病理報告皆證實為胃潰瘍併胃穿孔至心包膜。此病人最後順利康復出院。

關鍵字

胸痛 ； 食道重建 ； 胃潰瘍 ； 縱膈腔氣腫 ； 心包膜氣腫

並列摘要

Pneumopericardium and pneumomediastinum caused by retrosternal gastric tube ulcer after esophagoplasty is rare. A 73-year-old man who had received retrosternal esophageal reconstruction with gastric tube presented to the emergency department with chest pain and dyspnea. Chest radiography revealed pneumomediastinum, and chest computed tomography (CT) revealed conditions of pneumopericardium and pneumomediastinum. Emergency surgery including removal of retrosternal gastric tube, duodenostomy, partial pericardiectomy and tube thoracostomy was performed to repair the lesion and prevent life threatening complications. Perforation of a peptic ulcer from the retrosternal gastric tube into the pericardium was found during surgery and the diagnosis was proved by pathology. The patient recovered uneventfully.

並列關鍵字

chest pain ； esophagoplasty ； peptic ulcer ； pneumomediastinum ； pneumopericardium