医学
穿孔
围手术期
多学科方法
重症监护医学
剖腹手术
透视图(图形)
外科
普通外科
社会科学
计算机科学
社会学
人工智能
冶金
材料科学
冲孔
作者
Sumedha Wijeratne,Claudia Chong,Dinoo Suran Kirthinanda
出处
期刊:Case Reports
[BMJ]
日期:2022-12-01
卷期号:15 (12): e250816-e250816
被引量:1
标识
DOI:10.1136/bcr-2022-250816
摘要
Thyroid storm is a rare, fatal complication of thyrotoxicosis that necessitates aggressive medical treatment. We present a case of a patient who developed duodenal ulcer perforation as a result of a thyroid storm caused by Graves' thyrotoxicosis. In addition to life-threatening intra-abdominal sepsis complicated by high anion-gap metabolic acidosis, he was found to have severely deranged thyroid hormone levels and clinical features compatible with thyroid storm based on the Burch-Wartofsky Score. Diagnosis and management of such patients with compromised gastrointestinal (GI) tract present a remarkable clinical challenge to the anaesthetist and the intensivists. Multidisciplinary care with rapid preoperative optimisation, careful intraoperative anaesthetic techniques and postoperative care resulted in excellent outcomes. This case report sheds light on how to tailor general anaesthesia to minimise physiological derangement associated with thyroid storm and re-establish homeostasis in patients presenting for emergent surgery, particularly those with GI dysfunction.
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