AB216. SOH21AS036. An unexpected cause of acute decompensation in an elderly inpatient
Anaesthesia Poster Session

AB216. SOH21AS036. An unexpected cause of acute decompensation in an elderly inpatient

Clare Keaveney Jimenez, Kevin Doody

Department of Anaesthesiology and Intensive Care, University Hospital Limerick, Limerick, Ireland


Abstract: We present the case of a 76-year-old patient initially admitted with epistaxis on a background of oral anticoagulation for atrial fibrillation and a hiatus hernia. On the second day of admission the patient became acutely dyspnoeic, hypoxic, hypotensive and tachycardic. Metabolic acidosis was present on blood gas analysis. Vasopressor support was commenced and the patient was intubated and sedated. Initial stabilisation allowed an urgent CT scan to be performed which diagnosed a left diaphragmatic hernia with the stomach, descending colon, distal transverse colon and obstructed proximal jejunum located within the left hemithorax. Complete atelectasis of the left lung and volume loss in the right hemithorax with mediastinal shift to the right were present. The patient was ventilated on pressure control ventilation. Initially, inspiratory pressures of 40 cmH2O were required to achieve tidal volumes of approximately 310–330 mL. Following orogastric tube insertion and gastric decompression, tidal volumes increased to approximately 420–440 mL and required inspiratory pressure decreased. Electrolyte replacement and vitamin K were administered to optimise the patient for surgery. The patient was transferred to a specialised surgical centre for emergency surgical intervention. This case highlights diaphragmatic hernia to be considered as a cause of life-threatening rapid decompensation in a patient with a history of a hiatus hernia and the ventilatory value of gastric decompression when the stomach lies in the thorax.

Keywords: Acutely decompensated diaphragmatic hernia; diaphragmatic hernia gastric decompression; hiatus hernia; mechanical ventilation


Acknowledgments

Funding: None.


Footnote

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/map-21-ab216). The authors have no conflicts of interest to declare.

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Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


doi: 10.21037/map-21-ab216
Cite this abstract as: Jimenez CK, Doody K. AB216. SOH21AS036. An unexpected cause of acute decompensation in an elderly inpatient. Mesentery Peritoneum 2021;5:AB216.