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首页> 外文期刊>Journal of Medical Case Reports >Thoracic stomach syndrome after whole-stomach esophagectomy for esophageal cancer mimicking tension pneumothorax: a case report
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Thoracic stomach syndrome after whole-stomach esophagectomy for esophageal cancer mimicking tension pneumothorax: a case report

机译：全胃食管切除术治疗模拟张力性气胸的食管癌后胸胃综合征：一例报告

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Abstract BackgroundSudden onset of respiratory failure is one of the most fearful manifestations in intensive care units. Among the differential diagnoses of respiratory failure, tension pneumothorax is a life-threatening disease that requires immediate invasive intervention to drain the air from the thoracic cavity. However, other etiologies with manifestations similar to those of tension pneumothorax should also be considered after whole-stomach esophagectomy for esophageal cancer. We report a rare case of a patient with thoracic stomach syndrome mimicking tension pneumothorax after esophagectomy with whole-stomach reconstruction.Case presentationA 49-year-old Asian woman was admitted to our intensive care unit after esophagectomy for esophageal cancer with whole-stomach reconstruction while under sedation and intubated. Despite initial stable vital signs, the patient rapidly developed tachypnea, low blood pressure, and low oxygen saturation. Chest radiography revealed a mediastinal shift and led to a presumptive diagnosis of tension pneumothorax. Hence, an aspiration catheter was inserted into the right pleural space. However, her clinical symptoms did not improve. Chest computed tomography was performed, which revealed a significantly distended reconstructed stomach that was compressing the nearby lung parenchyma. Her respiration improved immediately after nasogastric tube placement. After the procedure, we successfully extubated the patient.ConclusionsSimilar to tension pneumothorax, thoracic stomach syndrome requires immediate drainage of air from the thoracic cavity. However, unlike tension pneumothorax, this condition requires nasogastric tube insertion, which is the only way to safely remove the accumulated air and avoid possible complications that could occur due to percutaneous drainage. For patient safety, it might be clinically important to place nasogastric tubes after esophagectomy with whole-stomach reconstruction, even if radiographic guidance is required. In addition, clinicians should consider thoracic stomach syndrome as one of the differential diagnoses of respiratory failure after whole-stomach esophagectomy.
机译：摘要背景呼吸衰竭的突然发作是重症监护病房中最令人恐惧的表现之一。在呼吸衰竭的鉴别诊断中，张力性气胸是一种威胁生命的疾病，需要立即采取侵入性干预措施才能从胸腔排出空气。但是，在食管癌全胃食管切除术后，也应考虑其他表现与张力气胸相似的病因。我们报道了一例罕见的胸腔综合征患者，该患者在全食管食管切除术后模拟张力性气胸。案例介绍一名49岁的亚洲女性在食管切除术后因全食管食管癌而接受了食管癌的重症监护病房。在镇静下并插管。尽管最初的生命体征稳定，但患者仍迅速出现呼吸急促，血压低和氧饱和度低。胸部X光片显示出纵隔移位，并推测为张力性气胸的诊断。因此，将抽吸导管插入右胸膜腔。但是，她的临床症状并没有改善。进行了胸部计算机断层扫描，显示出明显扩张的胃正在压缩附近的肺实质。放置鼻胃管后，她的呼吸立即得到改善。手术后，我们成功拔管了患者。结论与紧张性气胸相似，胸胃综合征需要立即从胸腔排出空气。但是，与张力气胸不同，这种情况需要插入鼻胃管，这是安全除去积聚的空气并避免因经皮引流而可能引起的并发症的唯一方法。为了患者安全，即使需要影像学指导，在食管切除术后全胃重建的情况下放置鼻胃管在临床上也可能很重要。此外，临床医生应将胸胃综合征视为全胃食管切除术后呼吸衰竭的鉴别诊断之一。

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