Role de l’anesthesiste-reanimateur dans les cas de rupture spontanee de l’Œsophage

Autor: Roberto L. Sia
Rok vydání: 1968
Předmět:
Zdroj: Canadian Anaesthetists’ Society Journal. 15:276-280
ISSN: 1496-8975
0008-2856
DOI: 10.1007/bf03008740
Popis: Nous soulignons l’importance qu’il y a a normaliser l’acidose, Pco2, electrolytes, infection, choc, avant d’envisager toute intervention chirurgicale. Un diagnostic bien au debut de la rupture a sans doute une tres grande influence sur l’intervention, le pronostic et le retablissement du malade. Dans notre cas, nous avons decouvert la rupture assez tard. Pour cela, des mesures purement conservatrices ont ete prises pour les raisons precipitees. Nous avons remarque que, pour ce genre de malade 1a neuroleptique (thalamonal) est peut-etre l’anesthesie de choix. Un controle periodique d’astrup, le bilan laboratoire et une radiographie furent faits pour suivre le processus. Pendant un mois a l’hopital universitaire d’Oulu, son etat general fut satisfaisant. Une gastrotomie fut pratiquee pour resoudre le probleme de la nutrition. La perte de poids a ete minime. A present, la fistule œsophagienne est fermee. Seul demeure le probleme de l’empyeme qui semble bien se resoudre sous traitement medical. Pourtant, nous croyons bien que quatre mois est la limite de traitement conservateur. Au dela, il faut considerer une intervention sur l’œsophage. In the treatment of spontaneous rupture of the oesophagus, we believe that the correction of acidosis, Pcom2 and electrolyte imbalance, infection, and shock has great importance before any immediate operation is decided upon. There is no doubt that early diagnosis of the rupture influences the surgical treatment, prognosis, and recuperation of the patient. In the case reported herein, the rupture was diagnosed rather late. The presence of acidosis, electrolyte disturbances, infection, and shock, and the frequent opening of the sutures when the operation is performed 24 hours after the rupture, have taught us to treat the patient conservatively. The patient described herein was placed under continuous antibiotics. Cortisone, pleural drainage and oral hygiene were administered, a nasogastric tube was inserted, and feeding was mainly through the gastrostomy tube. Neuro-leptanaesthesia (thalamonal) seems to be the method of choice in these cases. The patient was under periodic Astrup control, and laboratory tests and X-rays were taken in order to follow the process. During his one-month hospitalization in Oulu, his general state was satisfactory. The loss of weight was minimal. At present (less than a year later), the oesophageal fistula has already closed. Only the problem of empyeme still persists. We would hope that with medical treatment it will be resolved in due time. However, we believe that four months should be the limit of conservative treatment, and beyond that, surgical treatment of the oesophagus should be considered.
Databáze: OpenAIRE
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