背景:胃胸膜瘘是一种非常罕见的疾病,其发病率目前未知(Kunieda等人。inInternMed51(3):331,2012,https://doi.org/10.2169/internalmedicine.51.6823,Iqbal等人。inCureus11(2):e4136,2019,https://doi.org/10.7759/cureus.4136,Kathayanattetal.在印度肺37(2):174-175,2020年,https://doi.org/10.4103/lungindia。lungindia_242_17)。病因从创伤性或医源性损伤到因缺血引起的胃疝穿孔,溃疡,或者恶性肿瘤。
方法:一名27岁的欧洲男性到我院就诊,主诉全身无力和呼吸急促。患者入院前有一次咯血。计算机断层扫描显示左侧脓气胸,左主支气管缺损,右肺下部有肺炎的迹象.因此,胃底溃疡穿孔与膈下脓肿形成的罕见并发症,胃胸膜瘘,左肺坏疽,左主支气管圆形坏死,边缘舒张,左侧胸膜脓胸见本报告。
结论:虽然,对于这种可疑的恶性肿瘤,根治性手术可能更可取;对于患病患者,应仔细权衡败血症的风险和与延长手术相关的发病率.损伤控制手术对于重病患者来说可能是一个可行的选择,为以后保留更广泛的切除,前提是感染和出血的风险已经减轻。
BACKGROUND: Gastropleural fistula is an exceptionally rare condition, the incidence of which is currently unknown (Kunieda et al. in Intern Med 51(3):331, 2012, https://doi.org/10.2169/internalmedicine.51.6823 , Iqbal et al. in Cureus 11(2):e4136, 2019, https://doi.org/10.7759/cureus.4136 , Kathayanatt et al. in Lung India 37(2):174-175, 2020, https://doi.org/10.4103/lungindia.lungindia_242_17 ). The etiology varies from traumatic or iatrogenic injury to perforation in a herniated stomach due to ischemia, ulceration, or malignancy.
METHODS: A 27-year-old European male presented to our hospital with complaints of general weakness and shortness of breath. The patient had a single episode of hemoptysis before admission. A computed tomography scan demonstrated a left-sided pyopneumothorax, a defect in the left main bronchus, and signs of pneumonia in the lower sections of the right lung. Therefore, a rare complication of perforation of a gastric fundus ulcer with the formation of a subdiaphragmatic abscess, gastropleural fistula, gangrene of the left lung with circular necrosis of the left main bronchus and diastasis of its edges, and pleural empyema on the left is presented in this report.
CONCLUSIONS: Although, a radical surgery may be preferable for this suspected malignancy; it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient. Damage-control surgery may be a viable option for a very sick patient, with more extensive resection reserved for later, provided the risk of infection and bleeding has been mitigated.