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 |
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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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•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. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c345t-2130e243ed72df07df227b70746352f234429d4d76805f80e4f45fb077096b813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2739736558?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64394,72474</link.rule.ids></links><search><creatorcontrib>Katsuki, Shino</creatorcontrib><creatorcontrib>Miyamoto, Kazuyuki</creatorcontrib><creatorcontrib>Yamaga, Hiroki</creatorcontrib><creatorcontrib>Maeda, Atsuo</creatorcontrib><creatorcontrib>Takayasu, Hiromi</creatorcontrib><creatorcontrib>Yagi, Masaharu</creatorcontrib><creatorcontrib>Sasaki, Jun</creatorcontrib><creatorcontrib>Dohi, Kenji</creatorcontrib><creatorcontrib>Hayashi, Munetaka</creatorcontrib><title>Obstructive shock due to right ventricular compression by a massively expanded reconstructed gastric tube</title><title>The American journal of emergency medicine</title><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.</description><subject>Blood pressure</subject><subject>Cancer surgery</subject><subject>Compression</subject><subject>Electrocardiography</subject><subject>Emergency medical care</subject><subject>Enteral nutrition</subject><subject>Esophageal cancer</subject><subject>Food</subject><subject>Heart</subject><subject>Hiatal hernias</subject><subject>Hypotension</subject><subject>Laboratories</subject><subject>Lactic acid</subject><subject>Massive dilated gastric tube</subject><subject>Nutrition</subject><subject>Obstructive shock</subject><subject>Patients</subject><subject>Rice</subject><subject>Right ventricle</subject><subject>Shock</subject><subject>Spine position</subject><subject>Tomography</subject><subject>Ultrasonic imaging</subject><subject>Ventricle</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kEtLxDAUhYMoOD7-gKuA69abV9OCGxFfMOBG16FNbjV1phmTdHD-vR3GtavLgfOde-8h5IpByYBVN0PZDrguOXBeQlMC00dkwZTgRc00OyYL0EIVlVb6lJylNAAwJpVcEP_apRwnm_0WafoM9ou6CWkONPqPz0y3OObo7bRqI7VhvYmYkg8j7Xa0pet2Fltc7Sj-bNrRoaMRbRgPibP6aNOepnnq8IKc9O0q4eXfPCfvjw9v98_F8vXp5f5uWVghVS44E4BcCnSaux606znXnQYtK6F4z4WUvHHS6aoG1deAspeq70BraKquZuKcXB9yNzF8T5iyGcIUx3ml4Vo0WlRK1bOLH1w2hpQi9mYT_bqNO8PA7Cs1g9lXavaVGmjMXOkM3R4gnO_feowmWY-jRefnv7Nxwf-H_wJj84BZ</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Katsuki, Shino</creator><creator>Miyamoto, Kazuyuki</creator><creator>Yamaga, Hiroki</creator><creator>Maeda, Atsuo</creator><creator>Takayasu, Hiromi</creator><creator>Yagi, Masaharu</creator><creator>Sasaki, Jun</creator><creator>Dohi, Kenji</creator><creator>Hayashi, Munetaka</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope></search><sort><creationdate>202212</creationdate><title>Obstructive shock due to right ventricular compression by a massively expanded reconstructed gastric tube</title><author>Katsuki, Shino ; Miyamoto, Kazuyuki ; Yamaga, Hiroki ; Maeda, Atsuo ; Takayasu, Hiromi ; Yagi, Masaharu ; Sasaki, Jun ; Dohi, Kenji ; Hayashi, Munetaka</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c345t-2130e243ed72df07df227b70746352f234429d4d76805f80e4f45fb077096b813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blood pressure</topic><topic>Cancer surgery</topic><topic>Compression</topic><topic>Electrocardiography</topic><topic>Emergency medical care</topic><topic>Enteral nutrition</topic><topic>Esophageal cancer</topic><topic>Food</topic><topic>Heart</topic><topic>Hiatal hernias</topic><topic>Hypotension</topic><topic>Laboratories</topic><topic>Lactic acid</topic><topic>Massive dilated gastric tube</topic><topic>Nutrition</topic><topic>Obstructive shock</topic><topic>Patients</topic><topic>Rice</topic><topic>Right ventricle</topic><topic>Shock</topic><topic>Spine position</topic><topic>Tomography</topic><topic>Ultrasonic imaging</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Katsuki, Shino</creatorcontrib><creatorcontrib>Miyamoto, Kazuyuki</creatorcontrib><creatorcontrib>Yamaga, Hiroki</creatorcontrib><creatorcontrib>Maeda, Atsuo</creatorcontrib><creatorcontrib>Takayasu, Hiromi</creatorcontrib><creatorcontrib>Yagi, Masaharu</creatorcontrib><creatorcontrib>Sasaki, Jun</creatorcontrib><creatorcontrib>Dohi, Kenji</creatorcontrib><creatorcontrib>Hayashi, Munetaka</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Katsuki, Shino</au><au>Miyamoto, Kazuyuki</au><au>Yamaga, Hiroki</au><au>Maeda, Atsuo</au><au>Takayasu, Hiromi</au><au>Yagi, Masaharu</au><au>Sasaki, Jun</au><au>Dohi, Kenji</au><au>Hayashi, Munetaka</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obstructive shock due to right ventricular compression by a massively expanded reconstructed gastric tube</atitle><jtitle>The American journal of emergency medicine</jtitle><date>2022-12</date><risdate>2022</risdate><volume>62</volume><spage>149.e5</spage><epage>149.e7</epage><pages>149.e5-149.e7</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>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.</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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