A ham sausage gets the kid into PICU…

2022-06-09 0 By

On this day, Zhuang zhuang (pseudonym) mother took her child to the third affiliated hospital of Zhengzhou University (provincial maternal and child Health care hospital, provincial women and children’s Hospital) children’s general surgery clinic.”Doctor, today I took ham sausage to amuse the child to play, let the child taste taste, the child bite began to cough frequently, breathing difficulties, phlegm, looking at the child can be uncomfortable, how the matter?””The child esophagus is still so narrow now, ham sausage is not card to trachea or esophagus, check it!”Zhuang zhuang is 7 months old now, suffering from congenital esophageal atresia. After birth, esophageal channel was established through esophageal anastomosis. Currently, esophageal stenosis still exists, and esophageal dilatation and molding are performed regularly.Plus, he had surgery for a congenital heart condition two weeks ago.His strong and inquiry carefully check, the doctor told the narrowest point of the esophagus is only 3.7 mm in diameter, is not a beans, he eat milk very well at ordinary times, have never eaten granular food, but careless parents gave him to eat a mouthful of even age child cannot smoothly swallowing sausage, finish eat in cough and difficulty breathing.The doctor analyzed that the ham sausage was probably stuck in the trachea or esophagus.After further upper gastrointestinal angiography examination, it was sure that there was a circular filling defect above the esophageal anastomosis, which was probably esophageal foreign body.Due to the sudden changes in the child’s condition, the symptoms of dyspnea and phlegm, the doctor recommended that he be hospitalized.After hospitalization, Zhuang zhuang faced two problems to be solved: the first is that ham sausage is likely to be stuck to esophageal stenosis, the need for endoscopic exploration;The second is zhuang Zhuang suddenly appeared frequent cough and dyspnea, in addition to gastric juice back into the trachea caused by irritating cough, trachea may also be foreign bodies, the need for tracheoscopy.The child is malnourished, weighing only 5 kg, and just underwent heart surgery half a month ago. Currently, she has a poor tolerance for examination and surgery. The multidisciplinary medical team of the Affiliated Hospital of The Third Year of Zhengzhou University considers whether the above two problems can be solved together, which can not only reduce the pain of the child, but also reduce the economic burden of the family.Therefore, the PICU ward contacted wang Yumei, director of pediatric gastroenterology, Fan Shunyang, director of pediatric cardiothoracic surgery, huang Hua, deputy director of pediatric general surgery for multidisciplinary consultation, and finally decided to use electronic bronchoscopy for trachea and bronchial exploration, to understand whether there is trachea foreign body and symptomatic treatment;Then, electronic bronchoscopy was used for esophageal exploration to understand the presence of esophageal foreign bodies and symptomatic treatment.After preoperative preparation, the PICU respiratory intervention team worked in an orderly manner under the guidance of Qiao Junying, director of PICU, and Xu Qingrong, deputy director of pediatric respiratory Department.On the basis of adequate analgesia and sedation, they first explored the trachea and bronchus to make sure there was no airway foreign body.Then the esophagus was examined and several irregular foreign bodies were found blocked above the anastomosis. The intervention team successfully removed the foreign bodies with basket type foreign body forceps, and there were 3 pieces of ham sausage in total!After taking out foreign body, zhuang zhuang smoothly wakes up, esophagus unobstructed, can drink milk again!In this process, the PICU interventional team solved two problems by only using electronic bronchoscope, not only probing the airway, but also removing the esophageal foreign body, which is really a mirror with two purposes, killing two birds with one stone!It is known that esophageal anastomotic stenosis is a common complication after congenital esophageal atresia, and balloon dilation is an effective treatment for esophageal stenosis after esophageal atresia.Many patients like Zhuang zhuang in the hospital pediatric surgery regular follow-up and esophageal dilation treatment.Qiao Junying here reminds that normal healthy infants can add complementary food at 6 months, and the character and texture of supplementary food should be from thin to thick, from fine to coarse, from mushy food to semi-solid or solid food, which is a gradual transition process.Children with esophageal stenosis should pay more attention to the diet, can not rush, in the liquid diet to granular food before the transition, we must evaluate the child’s esophageal diameter can let the food through smoothly, so as to avoid the occurrence of food fragments stuck in the esophageal stenosis.Text: Pediatric Intensive Care Department, Li Fan, Edited by Liang Xiao, Reviewed by Hua Xiaoya, Shi Yanxiang