Obstructive shock due to right ventricular compression by a massively expanded reconstructed gastric tube

Obstructive shock is often associated with poor right ventricular (RV) output and requires rapid obstruction release. A 54-year-old man was brought to our emergency department, presenting with shock. He had previously undergone esophagectomy with gastric interposition through the retrosternal route,...

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Veröffentlicht in:The American journal of emergency medicine 2022-12, Vol.62, p.149.e5-149.e7
Hauptverfasser: Katsuki, Shino, Miyamoto, Kazuyuki, Yamaga, Hiroki, Maeda, Atsuo, Takayasu, Hiromi, Yagi, Masaharu, Sasaki, Jun, Dohi, Kenji, Hayashi, Munetaka
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container_end_page 149.e7
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container_start_page 149.e5
container_title The American journal of emergency medicine
container_volume 62
creator Katsuki, Shino
Miyamoto, Kazuyuki
Yamaga, Hiroki
Maeda, Atsuo
Takayasu, Hiromi
Yagi, Masaharu
Sasaki, Jun
Dohi, Kenji
Hayashi, Munetaka
description Obstructive shock is often associated with poor right ventricular (RV) output and requires rapid obstruction release. A 54-year-old man was brought to our emergency department, presenting with shock. He had previously undergone esophagectomy with gastric interposition through the retrosternal route, after which he could not eat solid foods. After eating a ball of rice, he became critically ill, with a significantly increased lactate level, an indicator of shock. Though initial examinations showed no abnormalities, he was hospitalized for observation. The following day, he experienced similar discomfort while in the supine position, an hour after breakfast. Cardiac sonography revealed that the RV was remarkably compressed by a massively expanded gastric tube, causing diastolic dysfunction. After propping him into a sitting position, he recovered from shock. Upon a second examination of CT images, we recognized the massively dilated gastric tube compressing the RV. Anatomically, the retrosternal route is located directly in front of the RV. Thus, it is thought that the massively dilated gastric tube externally compressed the RV, preventing adequate RV filling and causing the obstructive shock. In such cases, the patient's position should be changed immediately to release the RV compression. •Obstructive shock requires rapid obstruction release.•The gastric interposition in retrosternal route locates directly in front of the right ventricle.•The right ventricular pressure is remarkably low.•Massive dilated reconstructed gastric tube could compress right ventricle and induces obstructive shock.
doi_str_mv 10.1016/j.ajem.2022.09.017
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A 54-year-old man was brought to our emergency department, presenting with shock. He had previously undergone esophagectomy with gastric interposition through the retrosternal route, after which he could not eat solid foods. After eating a ball of rice, he became critically ill, with a significantly increased lactate level, an indicator of shock. Though initial examinations showed no abnormalities, he was hospitalized for observation. The following day, he experienced similar discomfort while in the supine position, an hour after breakfast. Cardiac sonography revealed that the RV was remarkably compressed by a massively expanded gastric tube, causing diastolic dysfunction. After propping him into a sitting position, he recovered from shock. Upon a second examination of CT images, we recognized the massively dilated gastric tube compressing the RV. Anatomically, the retrosternal route is located directly in front of the RV. Thus, it is thought that the massively dilated gastric tube externally compressed the RV, preventing adequate RV filling and causing the obstructive shock. In such cases, the patient's position should be changed immediately to release the RV compression. •Obstructive shock requires rapid obstruction release.•The gastric interposition in retrosternal route locates directly in front of the right ventricle.•The right ventricular pressure is remarkably low.•Massive dilated reconstructed gastric tube could compress right ventricle and induces obstructive shock.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2022.09.017</identifier><language>eng</language><publisher>Philadelphia: Elsevier Inc</publisher><subject>Blood pressure ; Cancer surgery ; Compression ; Electrocardiography ; Emergency medical care ; Enteral nutrition ; Esophageal cancer ; Food ; Heart ; Hiatal hernias ; Hypotension ; Laboratories ; Lactic acid ; Massive dilated gastric tube ; Nutrition ; Obstructive shock ; Patients ; Rice ; Right ventricle ; Shock ; Spine position ; Tomography ; Ultrasonic imaging ; Ventricle</subject><ispartof>The American journal of emergency medicine, 2022-12, Vol.62, p.149.e5-149.e7</ispartof><rights>2022 Elsevier Inc.</rights><rights>2022. 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Thus, it is thought that the massively dilated gastric tube externally compressed the RV, preventing adequate RV filling and causing the obstructive shock. In such cases, the patient's position should be changed immediately to release the RV compression. •Obstructive shock requires rapid obstruction release.•The gastric interposition in retrosternal route locates directly in front of the right ventricle.•The right ventricular pressure is remarkably low.•Massive dilated reconstructed gastric tube could compress right ventricle and induces obstructive shock.</abstract><cop>Philadelphia</cop><pub>Elsevier Inc</pub><doi>10.1016/j.ajem.2022.09.017</doi></addata></record>
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subjects Blood pressure
Cancer surgery
Compression
Electrocardiography
Emergency medical care
Enteral nutrition
Esophageal cancer
Food
Heart
Hiatal hernias
Hypotension
Laboratories
Lactic acid
Massive dilated gastric tube
Nutrition
Obstructive shock
Patients
Rice
Right ventricle
Shock
Spine position
Tomography
Ultrasonic imaging
Ventricle
title Obstructive shock due to right ventricular compression by a massively expanded reconstructed gastric tube
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