A 59-year-old male patient came to the hospital because of throat discomfort and difficulty swallowing food for the past few months, plus a slight cough.
In fact, he had been to the community hospital before that. Once the community doctor asked about his medical history, he learned that he had been having difficulty swallowing food for the past 2 months or so, whether it was bread or porridge, and seemed to have some difficulty, so he was advised to go to a big hospital to see if it was esophageal cancer.
Esophageal cancer? How can there be esophageal cancer? No one in my family has cancer.
This is a typical “progressive dysphagia”, we must be alert to the possibility of esophageal malignant tumor. At first, it may be difficult to eat bread, but later it is difficult to drink water …..
You must go to a major hospital and have a gastroscopy to see. The community doctor advised again and again.
The patient was shocked and was preparing to look at a higher level hospital. But somehow, the situation was surprisingly better for those few days, plus I had to work during the day, so I forgot about it.
It wasn’t until one day that the dysphagia worsened again and the cough worsened that he remembered to go to a major hospital.
When I came to the hospital, once I said I had difficulty swallowing, the doctor was alerted that it might be another esophageal cancer. Especially when they heard that the patient usually loves to drink tea and hot tea, they considered that the patient had esophageal cancer.
A gastroscopy was performed and the doctor quickly prescribed the test.
The patient also knew that the gastroscopy would be done long time ago, so he was prepared and paid the money and went to prepare for the examination.
Before the gastroscopy, a chest X-ray and ECG were done. The chest X-ray indicated a little pneumonia, which was not serious. The ECG was good. Must do electrocardiogram, after all, doing gastroscopy is some risk, in case the patient has myocardial ischemia, fear of problems.
Also took blood tests, do routine blood, routine blood results came out quickly, hemoglobin only 70g / L (reference value of 120-150), this is a moderate anemia ah, the doctor said. How can you be anemic? Do you usually have bleeding hemorrhoids?
There are hemorrhoids, but the bleeding is not serious ah, occasionally a little bleeding. The patient himself wondered, “I bleed a little when I brush my teeth, does this count?
No, how much can you brush your teeth to cause such severe anemia? The doctor explained that it could be a bleeding esophageal cancer or a bleeding stomach ulcer.
When the patient heard this, he became even more worried.
He was scheduled to have a gastroscopy.
The gastroscopy was just as the doctor expected, but it was also beyond the doctor’s expectation. There was a mass in the lower esophagus, the lumen was severely narrowed, and there was bleeding, and blood was still oozing at the time of the examination. The doctor wanted to cross the mass to see what was going on in the stomach, but because of the severe narrowing and the tendency to bleed, he did not force his way in and suspended the gastroscopy.
It seems that it is really esophageal cancer, and it is likely to be a mid to late stage esophageal cancer.
I had to communicate with the family first before deciding, the situation was much more serious than expected.
When the patient’s family came to hear that it might be esophageal cancer, the military heart was shaken, should we continue the treatment? Should we consider surgery or radiotherapy or chemotherapy, and should we transfer to a specialized oncology hospital?
The siblings finally talked about it.
Cure!
It was also at this time that the patient suddenly vomited blood with a big mouth! The scene was once very frightening, doctors panicked, nurses also panicked, it is false to say not panic. Blood sprayed on the ground next to several young doctors.
Immediately organize resuscitation ah! Blood pressure fell to 80/40mmHg, the heart rate puma to 140 beats / min.
Blood must be transfused immediately to combat shock, and the bleeding must be stopped quickly. The patient had a mass in the lower esophagus, and there was bleeding, it should be bleeding there, but now in this situation, there is no way to stop the bleeding under gastroscopy, it is too fierce.
We had to find the surgeon, the ICU doctor, the head of the transfusion department, and the head of the medical department!
Fortunately, before the gastroscopy, the blood type was perfected, and blood was transferred as soon as possible, red blood cells, plasma, platelets and so on. The blood pressure medicine should also be on, a lot of rapid rehydration, hurry up the blood pressure up, or life is not safe.
The chief of gastroenterology came and said that he had never seen such violent bleeding from esophageal cancer before!
Is there any possibility of ruptured esophagogastric varices bleeding from cirrhosis? Or is there any hemorrhage from gastric ulcer?
Don’t analyze it yet, the patient’s blood pressure can’t take it anymore!
Can the mirror go in and look again? No way! It’s all blood, and it’s vomiting blood. It’s definitely arterial bleeding! It’s like a waterfall and it doesn’t tend to abate at all.
The patient’s heartbeat is slowing down! The nurse’s shaky voice shouted.
Push adrenaline! The director was on the spot.
Someone help! Ask the blood bank again if the blood has been delivered yet!
The surgeon also came and said weakly that there was no way to go on stage in such a situation. It looks like the rhythm of the heart is going to stop.
The endoscope couldn’t stop the bleeding, and the surgeon couldn’t go on stage. The medication couldn’t stop the bleeding, and the sudden waterfall of hemorrhage blinded everyone.
It stopped! The heartbeat stopped! Hurry up and press! Someone shouted.
…..
From vomiting blood to cardiac arrest, it took less than 5 minutes. The blood was not even transfused and the patient’s heart stopped. After nearly an hour of effort, the patient still left the earth forever.
The director, with an iron face, whispered, “Declare death and stop resuscitation.
The family was in chaos, what is this, not just a gastroscopy, how to do it and then the person died. Several sons and daughters were heartbroken and just contacted by phone to discuss the situation, but now they are all coming to the scene.
The medical department also came over to coordinate.
The development is so fast that there is no chance of even being transferred to the ICU for resuscitation. Then again, the patient could not stop bleeding, so it was futile to transfer to anywhere.
Everyone was down in the dumps, and even the uncles who came to pull the body away were lifeless.
It should be an esophageal cancer bleeding, but does not exclude the possibility of hemorrhage from a ruptured esophagogastric fundic vein or hemorrhage from a gastric ulcer, etc. The director explained to the family that such a case is very dangerous and asked your family to mourn.
Of course, the family did not accept it. Although esophageal cancer was suspected, it was not diagnosed after all, and it was so young. What’s more, he was able to talk and walk well in the morning, but after the gastroscopy in the hospital, he became like this, no one can stand it. It’s not like your doctor stabbed a blood vessel or something, it probably means this.
Then you can only autopsy.
The corpse still speaks, and the autopsy done by a third-party agency can maximize the facts presented.
The autopsy results came back, to everyone’s surprise!
The patient did not have esophageal cancer.
There was no ruptured esophagogastric fundic varices bleeding.
There was no hemorrhage from a gastric ulcer.
Instead, there was a fish bone in the lower part of the esophagus! The fish bone, almost 1.5 cm long, directly penetrated the whole esophageal wall, and the surrounding tissue was necrotic and covered with granulation tissue, and the esophageal mass was actually formed by the necrotic tissue and the surrounding inflammation and granulation tissue, and part of the tissue was mechanized (chronic inflammation). The fish bone punctured the esophagus and a large artery, causing perforation and bleeding!
The deceased was consistent with the fish bone remaining in the esophageal wall for a long time causing perforation and bleeding of the esophagus to the point of hemorrhagic shock and death!
The truth is revealed.
It is estimated that the patient a few months ago ate fish, there are fish bones pierced to the esophagus, but at that time may not be serious, has been left in the esophageal wall, did not go down completely, so there has been uncomfortable swallowing performance. However, the patient did not inform the doctor of this condition at that time, and the doctor did not ask about this condition, so this aspect has not been considered.
This is a rare case.
It is very common to swallow fish bones by mistake. Although I myself am a child growing up by the sea, I am still very clumsy in eating fish, and I have the experience of being stabbed in the throat by fish bones several times a year, but it is 100% a minor problem that gets better after two days on its own, or swallowed into my stomach on its own. In fact, whether it is swallowing buns, rice, vinegar or other things are not the best, and even some of them may be harmful, the best should be to go to the quintuplet with a clip out, but it is too much trouble, so each time is a fluke to let it disappear by itself, fortunately so far are lucky.
But we won’t always be so lucky.
Finally, if you really have difficulty in swallowing in recent months, you must be alert to esophageal cancer, especially for those in Guangdong area, quitting smoking, drinking and not eating hot food may help prevent esophageal cancer
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