Spontaneous rupture of the esophagus is a relatively uncommon event, and recurrent rupture is extremely rare. We present a patient who experienced and survived 2 spontaneous perforations of the esophagus, occurring 6 years apart. A 43-year-old man was admitted to our hospital with upper abdominal pain after vomiting. Esophagoscopy, esophagogram, and computed tomography were suggestive of esophageal rupture. Emergency left thoracolaparotomy revealed a 20-mm perforation of the left lower esophageal wall that had been previously repaired. After the perforation was repaired with a single-layer closure, the mediastinum and pleural cavity were drained. The patient recovered well and was discharged from the hospital on postoperative day 29. To the best of our knowledge, only 7 previous cases of recurrent spontaneous esophageal perforation have been reported in the literature.
We report a case of a teenage male with penetrating cardiac injury (IIIb). He injured himself when he slipped and fell down the stairs into a display case. The glass shards pierced the region around his sternum, and he was transported to the Emergency and Critical Care Center of this hospital. Upon arrival at the hospital, the patient's level of consciousness was 10 on the Japan Coma Scale. His blood pressure was 80 mmHg; he had a heart rate of 130 bpm and decreased breath sounds in his right lung. He was given a rapid fluid infusion intravenously. Echocardiography did not reveal any accumulation of pericardial effusion. Chest drainage was performed because a portable chest Xray revealed a massive right hemothorax. Tracheal intubation was also carried out simultaneously. The chest tube drained 1700 ml of blood when inserted. As the patient responded to infusion and blood transfusion, contrast-enhanced computed tomography scans of the chest and abdomen were taken. The patient went into shock again upon returning to the emergency room, and a decision to perform thoracotomy for hemostasis was made. Through a right anterolateral thoracotomy from the site of incision, pericardial bleeding was ascertained and diagnosed as Type IIIa right atrial damage (The Japanese Association for The Surgery of Trauma, Organ Injury Classification 2008). Transverse sternotomy was performed successively making this a clamshell thoracotomy. Insertion of the index finger into the damaged area of the right atrium stopped the bleeding, and the wound area was then clamped with Satinsky forceps. The damaged site and pericardium were sutured before the chest incision was closed up. The patient progressed favorably and was ambulant at discharge on postoperative day 15. The present case was complicated by mild pericardial damage but it happened to progress without developing into cardiac tamponade, and the hemothorax was of the type that bled slowly into the thoracic cavity; hence, the patient did not experience cardiopulmonary arrest. The key to saving the lives of patients with penetrating trauma is the execution of uninterrupted rapid emergency care and hemostasis by a trauma team.
Table 1に心肺停止群と非心肺停止群に分け比較検討 したものを示したが,心肺停止群の転帰は全て死亡で あった。今回の検討により救急隊現場到着時に心肺停止 であった縊頸症例の救命は極めて難しいと推測された。 Table 2 Objective: To investigate and report cases of hanging admitted to our emergency medical center over the past 8 years. Method: We retrospectively examined medical records of 203 cases of hanging admitted to our center from January 2003 to June 2011. Results: Of the 203 cases, 154 were in a state of cardiopulmonary arrest (CPA) when the ambulance team arrived; none of them survived. While the prevalence of bystander cardiopulmonary resuscitation (CPR) was significantly higher in the second half than in the first half, there was no significant improvement in the outcomes. The results indicated that a score of 3 on Glasgow coma scale and occurrence of CPA were factors for bad prognosis. Conclusions: As with previous reports, we conclude that the prognosis of cases of hanging with out-of-hospital CPA is extremely poor.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.