|
medpundit |
||
 |
 |
|
Saturday, June 04, 2005The patient was promptly taken to the operating room, where she underwent transesophageal echocardiography, which showed no evidence of aortic dissection. A diagnosis of postinfarction rupture of the ventricular free wall was suspected on the basis of clinical, laboratory, and imaging findings. A median sternotomy was performed, and the pericardium was opened. After the evacuation of 600 ml of clotted blood, a bleeding site was identified in the right coronary artery, with bleeding due to perforation of the artery just before its bifurcation. Furthermore, when the diaphragmatic side of the heart was pulled up, a wooden toothpick, 3.5 cm long, was found and its passage through the diaphragm was identified. After ligation of the right coronary artery, bypass grafting with a saphenous vein was performed. A laparotomy was carried out after closure of the chest; neither inflammation nor intestinal content was found in the peritoneum. In addition, we did not find the passageway of the foreign body through the gastric wall. The postoperative course was uneventful. The patient was discharged after six days, and she returned to work after two months. The patient remembered having eaten meat rolls secured with toothpicks at a barbecue the night before her chest pain began. The authors say that tooth-pick injuries occur in the United states at a rate of 3.6 per 100,000 person-years. (Based on one survey that found 8176 toothpick-related injuries over a four year period.) Everything's a hazard. posted by Sydney on 6/04/2005 05:19:00 PM 0 comments 0 Comments: |
|
