Successful treatment of gastric perforation combined with hyperthyroidism crisis by MDT mode: a case report_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Ouyue ,  HUANG Cong

Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing 408000, P. R. China;

Corresponding?author：

HUANG Cong, Email: cqhuangcong@126.com

Keywords：

gastric perforation; hyperthyroidism crisis; acute peritonitis; surgery; multi-disciplinary team

DOI：

10.7507/1007-9424.201912104

Video：

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Objective To investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.Method We summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.Results This patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.Conclusion MDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.

Citation： WANG Ouyue, HUANG Cong. Successful treatment of gastric perforation combined with hyperthyroidism crisis by MDT mode: a case report. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 734-738. doi: 10.7507/1007-9424.201912104 Copy

1.	鄭彩虹, 郗光霞, 高林琳, 等. 甲狀腺危象死亡相關危險因素分析. 中國醫師雜志, 2019, 21(7): 1085-1087.
2.	M?ller MH, Adamsen S, Thomsen RW, et al. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol, 2010, 45(7-8): 785-805.
3.	黃衛東, 姚美芬. 甲亢危象的診治. 中華危重癥醫學雜志: 電子版, 2010, 3(1): 1-5.
4.	王玉付. 脾破裂合并甲狀腺危象的1例體會. 內蒙古中醫藥, 2014, 33(3): 129.
5.	李金榮. 外科急腹癥合并甲狀腺機能亢進圍手術期的處理 (附19例分析). 吉林醫學, 2012, 33(7): 1356-1357.
6.	Lanza FL, Chan FK, Quigley EM, et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol, 2009, 104(3): 728-738.
7.	國家風濕病數據中心, 中國系統性紅斑狼瘡研究協作組. 非甾體消炎藥相關消化道潰瘍與潰瘍并發癥的預防與治療規范建議. 中華內科雜志, 2017, 56(1): 81-85.
8.	M?ller MH, Adamsen S, W?jdemann M, et al. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol, 2009, 44(1): 15-22.
9.	Nuhu A, Kassama Y. Experience with acute perforated duodenal ulcer in a West African population. Niger J Med, 2008, 17(4): 403-406.
10.	S?reide K, Thorsen K, Harrison EM, et al. Perforated peptic ulcer. Lancet, 2015, 386(10000): 1288-1298.
11.	Boey J, Choi SK, Poon A, et al. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg, 1987, 205(1): 22-26.
12.	Buck DL, Vester-Andersen M, M?ller MH, et al. Surgical delay is a critical determinant of survival in perforated peptic ulcer. Br J Surg, 2013, 100(8): 1045-1049.
13.	Ogiso S, Inamoto S, Hata H, et al. Successful treatment of gastric perforation with thyrotoxic crisis. Am J Emerg Med, 2008, 26(9): 1065. e3-e4.
14.	Natsuda S, Nakashima Y, Horie I, et al. Thyroid storm precipitated by duodenal ulcer perforation. Case Rep Endocrinol, 2015, 2015: 750390.
15.	Williams MJ, Blair DW. Gastric secretion in hyperthyroidism. Br Med J, 1964, 1(5388): 940-944.
16.	邵偉, 鞏傳勇. 胃十二指腸潰瘍穿孔合并甲狀腺功能亢進圍手術期處理17例分析. 中國實用外科雜志, 2010, 30(2): 125-126.
17.	Zweig SB, Schlosser JR, Thomas SA, et al. Rectal administration of propylthiouracil in suppository form in patients with thyrotoxicosis and critical illness: case report and review of literature. Endocr Pract, 2006, 12(1): 43-47.
18.	Abubakar H, Singh V, Arora A, et al. Propranolol-induced circulatory collapse in a patient with thyroid crisis and underlying thyrocardiac disease: a word of caution. J Investig Med High Impact Case Rep, 2017, 5(4): 2324709617747903.
19.	Godo S, Kawazoe Y, Ozaki H, et al. Switching therapy from intravenous Landiolol to transdermal bisoprolol in a patient with thyroid storm complicated by decompensated heart failure and gastrointestinal dysfunction. Intern Med, 2017, 56(19): 2603-2609.
20.	Yamashita Y, Iguchi M, Nakatani R, et al. Thyroid storm with heart failure treated with a short-acting beta-adrenoreceptor blocker, Landiolol hydrochloride. Intern Med, 2015, 54(13): 1633-1637.
21.	黃政坤, 蘇海豐. 甲亢危象合并急性胃穿孔手術麻醉一例. 臨床麻醉學雜志, 2004, 20(7): 396.
22.	Wyble AJ, Moore SC, Yates SG. Weathering the storm: a case of thyroid storm refractory to conventional treatment benefiting from therapeutic plasma exchange. J Clin Apher, 2018, 33(6): 678-681.

1. 鄭彩虹, 郗光霞, 高林琳, 等. 甲狀腺危象死亡相關危險因素分析. 中國醫師雜志, 2019, 21(7): 1085-1087.
2. M?ller MH, Adamsen S, Thomsen RW, et al. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. Scand J Gastroenterol, 2010, 45(7-8): 785-805.
3. 黃衛東, 姚美芬. 甲亢危象的診治. 中華危重癥醫學雜志: 電子版, 2010, 3(1): 1-5.
4. 王玉付. 脾破裂合并甲狀腺危象的1例體會. 內蒙古中醫藥, 2014, 33(3): 129.
5. 李金榮. 外科急腹癥合并甲狀腺機能亢進圍手術期的處理 (附19例分析). 吉林醫學, 2012, 33(7): 1356-1357.
6. Lanza FL, Chan FK, Quigley EM, et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol, 2009, 104(3): 728-738.
7. 國家風濕病數據中心, 中國系統性紅斑狼瘡研究協作組. 非甾體消炎藥相關消化道潰瘍與潰瘍并發癥的預防與治療規范建議. 中華內科雜志, 2017, 56(1): 81-85.
8. M?ller MH, Adamsen S, W?jdemann M, et al. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol, 2009, 44(1): 15-22.
9. Nuhu A, Kassama Y. Experience with acute perforated duodenal ulcer in a West African population. Niger J Med, 2008, 17(4): 403-406.
10. S?reide K, Thorsen K, Harrison EM, et al. Perforated peptic ulcer. Lancet, 2015, 386(10000): 1288-1298.
11. Boey J, Choi SK, Poon A, et al. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg, 1987, 205(1): 22-26.
12. Buck DL, Vester-Andersen M, M?ller MH, et al. Surgical delay is a critical determinant of survival in perforated peptic ulcer. Br J Surg, 2013, 100(8): 1045-1049.
13. Ogiso S, Inamoto S, Hata H, et al. Successful treatment of gastric perforation with thyrotoxic crisis. Am J Emerg Med, 2008, 26(9): 1065. e3-e4.
14. Natsuda S, Nakashima Y, Horie I, et al. Thyroid storm precipitated by duodenal ulcer perforation. Case Rep Endocrinol, 2015, 2015: 750390.
15. Williams MJ, Blair DW. Gastric secretion in hyperthyroidism. Br Med J, 1964, 1(5388): 940-944.
16. 邵偉, 鞏傳勇. 胃十二指腸潰瘍穿孔合并甲狀腺功能亢進圍手術期處理17例分析. 中國實用外科雜志, 2010, 30(2): 125-126.
17. Zweig SB, Schlosser JR, Thomas SA, et al. Rectal administration of propylthiouracil in suppository form in patients with thyrotoxicosis and critical illness: case report and review of literature. Endocr Pract, 2006, 12(1): 43-47.
18. Abubakar H, Singh V, Arora A, et al. Propranolol-induced circulatory collapse in a patient with thyroid crisis and underlying thyrocardiac disease: a word of caution. J Investig Med High Impact Case Rep, 2017, 5(4): 2324709617747903.
19. Godo S, Kawazoe Y, Ozaki H, et al. Switching therapy from intravenous Landiolol to transdermal bisoprolol in a patient with thyroid storm complicated by decompensated heart failure and gastrointestinal dysfunction. Intern Med, 2017, 56(19): 2603-2609.
20. Yamashita Y, Iguchi M, Nakatani R, et al. Thyroid storm with heart failure treated with a short-acting beta-adrenoreceptor blocker, Landiolol hydrochloride. Intern Med, 2015, 54(13): 1633-1637.
21. 黃政坤, 蘇海豐. 甲亢危象合并急性胃穿孔手術麻醉一例. 臨床麻醉學雜志, 2004, 20(7): 396.
22. Wyble AJ, Moore SC, Yates SG. Weathering the storm: a case of thyroid storm refractory to conventional treatment benefiting from therapeutic plasma exchange. J Clin Apher, 2018, 33(6): 678-681.

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Successful treatment of gastric perforation combined with hyperthyroidism crisis by MDT mode: a case report

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