, pnevmomediastinuma, subcutaneous emphysema and cardiorespiratory collapse after gastroscopy. Pneumoperitoneum is a known complication of gastrointestinal perforation >>. << However, in the case of occult perforation, where
pneumoperitoneum did not initially obvious, endoscopy with gas insufflation
may cause tension pneumoperitoneum with
serious. 86-year-old woman presented to rural hospital with anorexia, diarrhea
,
adjective pain, sore right shoulder tip and signs correspond >> << with acute abdomen. It was translated into large regional hospital
, where upon arrival she Episode haematemesis. On examination she was
epigastrium and protection, not rebound tenderness or rigidity
. On rectal examination revealed melena. Right chest radiograph
not showed subdiaphragmatic free gas. It
find a bleeding ulcer and was prepared for
Looking stomach flexible instrument called a Gastroscopy view. gastroscopy,
l. Evaluation showed anesthesia in patients with marked
abdomen with cold peripheries and poor capillary refill >> << despite the generous amount of resuscitation. Its essential features are: BP
110/70 mmHg, heart rate 90 beats per minute, [S. sub. ] [O. sub. 2] 95% air. It was
) without fever. Anal. Bezlihoradochnyy. without fever. adjective. Gastroscopy was scheduled under general anesthesia with rapid induction of anesthesia with sequential perstnevydnoho pressure anesthesiology maneuvers, which rapidly induced anesthesia thiopental, succinylcholine is at the same time as surgical sister, anesthesia assistants or other concerns. It was complications from 0. 8 [micro] by [Kg. sub. 1] >> << fentanyl, 1. 3 mg. [Kg. sub. -1] And propofol 1. 2 mg. [Kg. sub. 1]
see succinylcholine. No longer relaxes muscles received. Her hemodynamic >> << parameters were stable during the 10-minute procedure. At gastroscopy >> << duodenum with old clots were found without active bleeding. After return of spontaneous ventilation, she developed marked tachypnea
with a small amount of breathing and low [S. sub. ] [O. sub. 2] 60%
([F. sub. I] [AN sub. 2] 1. 0). When she was still intubuvaty she was ventilation
help manually, achieving adequate respiratory volume, although with high
pressure in the airways (50-60 cm [N. sub. 2] O). It was noted that peryorbytalnoy
and facial swelling developed, which quickly turned into
generalized subcutaneous emphysema involving face, neck and chest. Tension pneumothorax was excluded clinically (Fig. 1). Trachea injuries >> << perforation of the esophagus were excluded from flexible bronchoscopy
and repeat gastroscopy. The patient remains hypotensive >> << At this time (70/40 mmHg), with severe acidosis (pH 6. << 94 >> [P. sub.] [Co. Sat. 2] 72 mmHg) and hypoxemia ([P. sub.] [AN sub. 2] 54 mm
on [FiO. sub. 2] 1. 0). Persistent hypotension followed by a sudden >> << profound bradycardia (HR 30). Adrenaline bolus improved
blood pressure and heart rate, but not saturated. Visceral injury
suspected and the patient was prepared for laparotomy. She was re
anesthesia and gave atrakuriyu then her belly >> << tension was much more noticeable. After laparotomy, an immediate reduction >> << intra-abdominal pressure has been achieved as a result of marked
improve airway pressure, saturation, and hemodynamics. Perforation
duodenum was identified and oversewn. Last >> << operation proceeded without complications and the patient was transferred to >> << intensive care unit for further management. Tension pneumoperitoneum in diagnostic gastroscopy
for peptic ulcer disease is extremely rare (1). As Taub et al (2)
ulcer perforation may sometimes be a wall spontaneously
), relating to the appendage. Anal. Related to the appendage. Relating to or arising from the appendage. wave. Subdiaphragmatic gas may not be radiographically as
enough time for gas absorption and re-signs the patient
improve spontaneously. Increase vnutrishlunkovoho pressure during gastroscopy
gives thin flap appendage that allows air insufflated >> << go out into the abdominal cavity. Omental flap, if present,
may also function as a one-way valve allows air to go with, but not >> << re-enter the gastrointestinal tract (3). In our case, tension pneumoperitoneum was further aggravated
on repeat gastroscopy and was exposed muscle relaxation with atrakuriyu.
Under high pressure, intraabdominal air can reach
me? where-a-stidnum
) Sq. mediastidna P [L. ]
1. The average partitioning or partition. 2. directly through diaphragmatic defects the drug lasix (4), or
retroperitoneal space and break the esophagus (5). Air from the
pnevmomediastinuma can track along fascial planes above the neck
face and chest, creating the observed subcutaneous emphysema.
This case highlights the importance of tension pneumoperitoneum as >> << cause life-threatening cardiorespiratory compromise. As mentioned
recently Ternlund etc. surplice, the stomach should be always carefully
, check in intensive care, especially where history
indigestion marked by corrosion of the stomach due to acid in the digestive juices. See duodenal ulcer, gastric ulcer, GERD. , A tension pneumoperitoneum can camouflage blanket
side or the patient. Another point shown in the article
Ternlund was saving procedure inserts
wide diameter cannula in a tense pneumoperitoneum - a procedure that
had to be done at the beginning of this case quickly relieve
cardiorespiratory compromise . (1). Chan SY, Kirsch CM, Jensen WA, Sherck J. voltage
pneumoperitoneum. West J Med 1996; 165:61-64. (2). Taub SJ, Nagurka C, Raskin JB. Tension pneumoperitoneum as a nontraumatic complication >> << endoscopy of the upper gastrointestinal tract. Gastrointest Endosc 1980; 26:153-154. (3). Olinde AJ, Carpenter D, Maher JM. Tension pneumoperitoneum:
cause of acute aortic occlusion. Arch Surg 1983; 118:13471350. (4). Hutkin Z, Iellin, Meged S, P Sorkine, Geller E. Spontaneous pneumoperitoneum without
peritonitis. Int Surg 1992; 77:219. (5). Hillman KM. Pneumoperitoneum: a review. Critical Care Med 1982;
10:476. (6). Ternlund SP, Brock-Utne JG. Failure to recognize tension
pneumoperitoneum during resuscitation. Anaesth Intensive Care 2006;
34:517-518. W Y. There
D. Bertholini
Bendigo, Victoria.
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