This report describes the sudden development of respiratory compromise caused by rapidly progressive subcutaneous emphysema after postoperative vomiting
. The differential diagnosis includes alveolar rupture, spontaneous rupture of the esophagus postemetic
(BoerhaaveBЂ ™ syndrome), and trauma hortanohlotky, trachea, or esophagus. Pnevmomediastinuma and subcutaneous emphysema as a result of alveolar rupture can occur after forceful vomiting. Increase
alveolar pressure produced by Valsalva during vomiting can rupture the alveolar lung in interstitsy >>. << From there, the air passes along the pulmonary vessels of the vagina, where it enters the mediastinum, and then analyzes through >> << soft tissue planes neck, producing subcutaneous emphysema. It has been demonstrated in experimental animals >> << and in humans (,
). Several other cases have been reported, but none describe the development of severe respiratory compromise (
BЂ "). These cases differ in the absence of complications and their spontaneous decision. This is in contrast to most cases
BoerhaaveBЂ ™ s syndrome, in which leakage esophageal and gastric contents into the mediastinum often causes
mediastinitis with associated complications (,
). Its classic presentation consists of a triad of vomiting, chest pain and subcutaneous emphysema, although not all
these symptoms are present in many cases (,
). Most authors believe that high levels of morbidity and mortality can be reduced early diagnosis and aggressive surgical treatment
, however, there are several reports of successful conservative treatment when leakage of the oesophageal >> << minimal or decreased ( BЂ
"). Because of the potentially insidious nature of small esophageal tear, it is possible that the gap in our place
patient could not be found (
). Other causes of subcutaneous emphysema in the postoperative period include injury of the pharynx, esophagus, trachea or from
laryngoscopy, intubation, Pererazduvanie the cuff endotracheal tube or gastric tube placement (,
). In our patient, there was no indication that any of these procedures were difficult or caused any injury, although occult
injury can not be completely ruled out. Start site of injury in the throat or hortanohlotky unlikely in this case, because
emphysema began in the chest, and from there spread to the cranial neck and head, and finally carried
symptoms in the respiratory tract. In addition, symptoms patientBЂ ™ s not developed after intubation and gastric tube placement, even for a few hours
ventilation with positive pressure, but is developing rapidly, immediately after the episode of forceful vomiting and vomiting,
suggest a causal relationship between these events.
No throat and respiratory tract lesions were identified, although one can be
was concealed significant swelling caused by emphysema. In the absence of obvious injury, it was impossible to definitively diagnose the symptoms of this patientBЂ ™ s,
but alveolar rupture is the most likely etiology. Future loss of airway was successfully prevented immediately woke
fiber-optic intubation, which may offer better visualization of airways and possibly the easiest and least traumatic method >> << tracheal intubation in this situation. We conclude that lasix online no prescription subcutaneous emphysema with extension into the soft tissue planes supraglottic airways may be a rare complication of postoperative vomiting
. Within minutes, it can lead to respiratory compromise, which may be a harbinger of change
in his voice. This should be immediately recognized as successfully providing airway before distortion of anatomy makes >> << intubation more difficult or impossible. Studies to determine the potential loss traheopischevodnyy justified, if not, >> << alveolar rupture is the most likely diagnosis and resolve spontaneously. .
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