Gucika kw’umuhogo (Indwara ya Boerhaave), Amarira ya Mallory-Weiss, n’Ugutera Ububabare bwo mu Gikiriza¶

Boerhaave syndrome ni indwara y’agahomerabunwa, ishobora gutuma umuntu apfa, aho umuvuduko w’amaraso wiyongera bukwi na bukwi, uturitse imbere mu gifu mu gihe umuntu ariko araruha canke ariko araruha ku nguvu, ugatabura umwobo wuzuye (transmural esophagus) gushika mu ruhome rw’igifu co hasi. Udakunze amarira ya Mallory-Weiss yo hejuru (akora gusa igihimba c’imbere c’umubiri c’aho inda n’umuhogo bihuriye, kigatuma haba amaraso atukura cane mu vyo gutakara ata gutobora igifu), indwara ya Boerhaave itera ibihimba vy’umubiri bifise aside, ibihimba vy’umubiri bifise aside, n’ibihimba vy’umubiri bifasha mu gufata ibiribwa, umwobo w’igikiriza utagira ubumara (igice c’imbere n’ikibanza c’ibubamfu). Kubera ko umuhogo udafise igihimba c’inyuma gikomeye c’umubiri, iyo nzira y’imiti n’imigera itera indwara y’umutima itera indwara y’umutima, empyema, tension hydropneumothorax, n’indwara y’umutima mu masaha makeyi. Iyo umuntu yariko araruha canke aruha (na cane cane iyo agerageje guhagarika ururungo ku nguvu) aca agira ububabare bubabaje cane mu gikiriza co hasi, mu nda yo hejuru, canke mu mugongo, akabura impwemu, canke **ibibumbano vy’umuyaga bica munsi y’urukoba rw’izosi (Mackler’s your local triad)**ll, inomero z'ivyihutirwa ubwo nyene. Mu gihe urindiriye abaganga, subiramwo ubuyobozi bujanye n’ivyihutirwa ku kuva amaraso mu nda no kuruka amaraso, imitsi y'umuhogo n'amaraso ava mu ndwara ya cirrhose, na igufa ry'ifi, igufa ry'inkoko, n'ibifungurwa.

Kubera ko indwara ya Boerhaave itavuwe ishobora kwica hafi 100 kw’ijana (kandi urupfu rwiyongera kabiri iyo umuntu abazwe canke akoresheje endoscope bicerewe gushika amasaha 24), itegeko ryawe rimwe gusa rihambaye cane ry’ubutabazi bwa mbere muhira ni **NPO idasanzwe (nta kintu na kimwe mu kanwa: mbere n’igihe cose umuntu anywa inzoga yose) itosi ry’amazi yamizwe risuka rigororotse rivuye mu mwobo wo mu nzira y’amaraso rikaja mu mfuruka y’igikiriza.

Ivyo ubikore ubu¶

1. Hamagara ku nimero y’ivyihutirwa yo mu karere kawe ubwo nyene maze umenyeshe iyo wikekwa ko ufise indwara y’ugutoboka kw’umuhogo / Boerhaave. Hamagara kuri 911 muri Leta Zunze Ubumwe za Amerika no muri Canada, 112 mu Bumwe bw’Uburayi bwose, 999 mu Bwongereza, 000 muri Australiya, canke urabe urutonde rwacu rw’abantu inomero z'ivyihutirwa. Vuga neza: "Ivyiyumviro vy'uko umuntu afise indwara ya Boerhaave / ruptured esophagus: ububabare bubabaje butunguranye mu gikiriza no mu mugongo wo hejuru ubwo nyene umuntu amaze gukorora ku nguvu, n'uguhumeka nabi."
2. Gushira mu ngiro NPO (amazi ZERO, zero ice chips, zero antasides, zero pills yo mu kanwa). Umuntu amaze guruka, kamere yiwe ni iyo kunywa ikirahuri c’amazi, ginger ale, canke antasy y’amazi kugira ngo yoze uburyohe busharira mu kanwa kiwe no guhoza ububabare bwiwe. Iyo uwo muntu yipfuza gukaraba akanwa, arashobora gusukura amazi akanye akayasuka 100 kw’ijana mu gikarabiro, ariko ntategerezwa kwigera amira n’itonde na rimwe. Amazi amira agenda agororotse aciye mu marira ari mu nzira y’amaraso aja mu gice c’imbere n’inyuma gikikuje umutima n’amahaha y’ibubamfu, akayoza imigera amamiliyoni yo mu kanwa ataco akora mu gikiriza.
3. Ushire umurwayi yicaye ahagaze ku rugero rwa degre 30 gushika kuri 45 (canke yihetse gatoyi imbere) kugira ngo ashobore guhema neza kandi agabanye aside igaruka mu mugongo. Kuryama hasi ku mugongo bituma aside yo mu nda n’amaraso biva mu nda bishobora gutera hejuru biciye mu nzira y’amaraso yo hasi bikaja mu nzira y’amaraso y’amaraso. Kwicara umuntu ahagaze neza bikoresha uburemere bw’isi kugira ngo aside yo mu nda igume iri hasi mu nda kandi bifasha amahaha kwaguka ku bijanye n’ugutera kw’amaraso y’ibubamfu canke pneumothorax.
4. Suzuma ahantu h'izosi n'amagufa y'ibere ko ata "rice-krispie" isaduka munsi y'urukoba (emphysème subcutaneous / triade de Mackler). Ruhutsa buhoro buhoro ibipande vy'intoke zawe hejuru y'umwobo uri hejuru y'igufa ry'ibere (suprasternal notch), ujabuke amagufa y'izosi. Iyo wumvise utuvungukira dutoduto tw’umuyaga dutera kandi tugasaduka munsi y’urukoba nk’impapuro z’impuzu canke umuceri w’ibitoke (crepitus), canke iyo izosi risa n’irivyimba kandi ijwi ry’uwo muntu rivuga bukwi na bukwi nk’iry’amazuru canke ry’ugusesagura, umuyaga uva mu nzira y’umuhogo utaburutse urakurikirana neck mediast.
5. NTUHE aspirine, ibuprofen, canke umuti uwo ari wo wose wo mu kanwa, kandi wirinde gutuma umuntu agira uwundi muntu atera umutwe canke akaruha. Bwira abaganga ubwo nyene iyo bashitse kugira ngo bashobore gutanga imiti yo gukingira umutwe (ondansetron) ubwo nyene kugira ngo uhagarike gutera umutwe (kuko iyo aside yose yongeweko itera umutwe).
6. Ukurikirane neza ko ata n’umwe afise uguhungabana vuba, cyanose, n’uguhungabana kw’umutima. Iyo amarira y’umuhogo aciye mu left mediastinal pleura iri hafi, umuyaga n’amazi yo mu nda birasesagura ikibanza gikikuje amahaha y’ibubamfu, bigatuma amahaha asenyuka maze bikasunika umutima w’igifu c’iburyo.

Igiti c'ingingo: ububabare bwo mu gikiriza inyuma yo kuruka, hematemesis, n'ugutoranya indwara ya Boerhaave¶

flowchart TD
    Start["Gusesa amaraso ku nguvu, gusesa amaraso yumye, canke gusesa amaraso bikurikiwe n’ububabare bwo mu gikiriza, ububabare bwo hejuru mu nda, canke gusesa amaraso"] --> CheckMackler{"Intambwe ya 1: Suzuma Boerhaave Syndrome & Mackler Triad Amabendera atukura: Ububabare bubabaje bukwi na bukwi bwo gutabura mu gikiriza canke mu mugongo, gutera ibibumbano vy’umuyaga munsi y’urukoba rw’izosi (crepitus), guhumeka nabi, canke Hamman crunch?"}

    CheckMackler -->|"EGO ku Ibendera ryose ry'Umutuku"| Boerhaave["ABAKEKA KUBA ABAFISE INDWARA YA BOERHAAVE (GUTABUKA KW’UMUNTU): Hamagara abajejwe ivy’ubutabazi (911 / 112 / 999) Ubwo nyene; Idirisha ry'inzahabu ry'amasaha 24 ryo kwirinda indwara y'umutima yica"]

    CheckMackler -->|"NTA kubabara cane mu gikiriza canke mu mugongo canke guhema nabi; Umurwayi araruha amaraso atukura cane amaze guruha"| MalloryCheck{"Intambwe ya 2: Amaraso angahe & Umurwayi Afise Cirrhose y'Igitigu?"}

    MalloryCheck -->|"Cirrhose izwi / Portal Hypertension CANKE Amaraso menshi, ibihimba vy'umubiri vyirabura, gusinzira, canke amavyi y'umwirabura"| Varices["AMARASO YO MU GI HEJURU YO GUTERA UBUZIMA AKAGA CANKE GUTABUKA KW'IBIMENYETSO: Hamagara 911 Ubwo nyene, Uhagarare ku ruhande, NPO ikomeye"]

    MalloryCheck -->|"Uturongo dutoduto tw’amaraso atukura cane inyuma yo guruka kenshi, nta kubabara mu gikiriza, guhema bisanzwe, umuvuduko w’amaraso n’umuvuduko w’amaraso bisanzwe"| MalloryWeiss["Amarira y’umubiri yikekwa ko afise ubumuga bwa Mallory-Weiss: Gumana NPO ata gufyina maze ugende mu bitaro vy’ibiza kugira ngo basuzume umugera wa hemoglobine, basuzume umuti wo gukingira pompe ya proton IV, kandi bawusuzume"]

    Boerhaave --> StrictNPO["1. NPO IKOMEYE: NTUMIRE N’Amazi 1 (Amazi amize asuka agororotse amarira y’umuhogo mu gikiriza); Icara uhagaze neza ku bushuhe bwa degre 30 gushika kuri 45 kugira ngo aside yo mu nda igume hasi"]

    StrictNPO --> HospitalBundle["2. Igikoresho co gupima no gusubiza ubuzima mu bitaro: Ondansetron yo mu maraso, umuti wo gukingira ipompa y’amaprotoni, imiti irwanya indwara y’ibicurane + irwanya ibicurane (Fluconazole), CT Esophagogram n’ibikoresho bishobora gusenyuka mu mazi (Gastrografin, NEVER Barium), canke Endoscopic S"]

Ivyerekeye umubiri n’ivy’indwara: igituma umuhogo wama utabuka ahantu hamwe nyene (Uruhome rw’Ibubamfu rw’Inyuma)¶

Ivyo vyavuzwe ubwa mbere mu 1724 n’umuganga w’Umuholandi Herman Boerhaave amaze gukora igikorwa co gupima umubiri wa Baron Jan von Wassenaer, Umukuru w’Ingabo z’Umuholandi (yari yinjiye mu birori vyinshi, afata umuti wo gusesa amaraso, aravunika cane, asemerera ngo “hari ikintu cari caravunitse mu gikiriza ciwe kandi cari caravunitse mu gikiriza ciwe. amavuta ya elayo areremba imbere mu mfuruka y’igikiriza ciwe c’ibubamfu), Boerhaave syndrome (uguca ibice kw’umuhogo) ikurikije amategeko y’ubuhinga bw’ibinyabuzima ashobora kumenyekana.

1. Kubera iki 90% vy’ibisebe vya Boerhaave bishika mu gice co hasi c’ibubamfu¶

Iyo uguruka guturika gutuma umuvuduko wo mu muhogo uri hejuru ya 150 gushika kuri 300 mmHg, amarira hafi y’igihe cose aba nk’ugucapura kw’uburebure guhagaze (uburebure bwa sentimetero 1 gushika kuri 4) ku ruhome rw’inyuma rw’ibubamfu rw’umuhogo wo kure cane above2 to4. ihuriro ry’igifu (hejuru y’igihimba c’umubiri). Intege nke zine z’umubiri zihurira muri ako gace nyako (Ikibanza c’intege nke c’umubiri ca Korn):

1. Kubura igice c’inyuma c’amaraso: Bitandukanye n’inda n’amara, ivyo bikaba bizingiwe n’igice c’inyuma gikomeye kandi gifise intsinga citwa serosa (peritoneum viscérale) gifise kolajeni n’insinga zikomeye, igihimba c’inyuma c’umubiri gifise **insinga zidafise imitsi y’amaraso na gato, n’umubiri ufatanya n’ibindi bihimba vy’umubiri.
2. Uguceceka no gukwiragira kw’imitsi y’uburebure: Mu gice ca gatatu co hasi c’umuhogo, imitsi y’inyuma y’uburebure iryoshe irapfunyarika kandi igakwiragira nk’umuyaga uko yibira hasi kugira ngo yinjire mu mutima w’inda.
3. Ivyiyumviro vy’imitsi y’ubwonko bica mu ruhome rw’imitsi: Ku ruhome rw’inyuma rw’ibubamfu hejuru gato y’igihimba c’umubiri, amashami y’umutsi w’ibubamfu w’igifu n’umutsi w’umubiri w’umubiri utobora ataco uhinduye mu gice c’imitsi y’uruziga, bikaba bituma habaho utunenge tw’imiterere (loci minoris resistentiae).
4. Kubura ingingo z’inyuma zifasha ku ruhande rw’ibubamfu: Mu gihe uruhande rw’iburyo n’imbere rw’umuhogo wo hasi bishigikiwe hanze n’umutsi w’amaraso wo mu gikiriza, umugongo, umutsi w’umutima, n’umutsi w’inyuma w’umuhogo, iyo uruhome rw’inyuma rw’umuhogo wo hasi rw’inyuma rw’umuhogo wo hasi rufatanye ata guca ku ruhande n’umuhogo w’inyuma w’umuhogo wo hasi n’ibipimo vy’umukazo wo mu mutima.

2. Igitero c'urupfu: indwara y'imitsi y'umubiri ikurikirwa n'uguhungabana kw'imigera myinshi¶

Igihe uruhome rwo hasi rw’ibubamfu rw’umuhogo rucapura, impwemu yose umurwayi afata ikora nk’ipompo y’ubusa: kubera ko umwobo wo mu gikiriza (ikibanza c’amafyigo n’ivy’imbere mu gikiriza) uguma munsi ya umuvuduko mubi wo mu gikiriza (-5 ku -10 cmH2O) mu gihe co guhema mu gihe inda iri munsi y’igihimba c’umubiri iri munsi ya positive intra-abdominal pressure, ibiri mu nda biguma binyobwa biva hejuru biva mu nda bica bifumbirwa biciye mu nzira y’amarira y’umuhogo bikaja mu gikiriza:

• Amasaha 0 gushika ku 6 (Indwara y’imiti n’uguhungabana kw’ikibanza ca gatatu): Asidi y’amazi yo mu nda (pH 1,5 gushika kuri 2,0), pepsine, n’amaraso y’umubiri asubira mu nda bifata ibinure vyo mu nda maze bikaturika biciye mu nzira y’amaraso y’ibubamfu, bikasuka amazi n’umuyaga mu gifu c’ibubamfu (hydrtyvithore**le 70 gushika ku 90 kw’ijana vy’abarwayi). Ugusohoka kw’imitsi myinshi cane gukura amalita y’amaraso mu maraso akaja mu gikiriza, bigatuma umuntu agira ubwoba bwihuta.
• Amasaha 6 gushika kuri 24+ (Indwara y’umusonga itera imigera myinshi): Imigera yo mu kanwa n’iyo hejuru y’umubiri (Streptococcus viridans, Staphylococcus, Enterobacterales, imigera yo mu kanwa idafise umwuka nka Prevotellades* na Multidap) n’ibindi bihimba vy’umubiri bifise imitsi y’inyuma bikikuje umutima, umutsi w’amaraso n’amahaha, bikaba bituma urupfu ruva ku munsi y’ibice 10 gushika ku bice 15 kw’ijana (iyo umuntu abazwe mu masaha 12 gushika ku bice 24) gushika ku bice 40 gushika ku bice 60+ kw’ijana (iyo bitevye gushika ku bice 82 kw’ijana).

Gutandukanya indwara ya Boerhaave, amarira ya Mallory-Weiss, n’amarira y’umuhogo¶

Kubera ko ivyo bimenyetso vyose bitatu birimwo gukorora, gukorora, n’ibimenyetso vyo mu nda yo hejuru, gutandukanya ugucika kwa Boerhaave kw’uburemere bushitse n’ugucika kw’amarira y’umubiri wa Mallory-Weiss** canke amaraso y’ibihimba vy’umubiri ni ikintu gihambaye cane:

Kumenya Ubutatu bwa Mackler, Ubutatu bwa Anderson n’Ikimenyetso ca Hamman kiri iruhande y’igitanda¶

Abaganga bizigira ibimenyetso bibiri vy’ubutatu vya kera biri iruhande y’igitanda be n’ibimenyetso bitatu vyo gusuzuma umubiri kugira ngo bafate indwara ya Boerhaave imbere y’uko bayimenya nabi ko ari indwara y’umutima, ugucagura umutsi w’amaraso, indwara y’amahaha canke indwara y’amafyigo:

1. Ubutatu bwa Mackler (Ubutatu bw’igitabu ca kera bw’indwara ya Boerhaave)¶

1. Guruka canke Gusuka ku nguvu (naho rimwe na rimwe biterwa n’ugukorora cane, guterura ibiremereye, gufatwa n’indwara y’igicuri, guhagarika umutima mu gihe co kuvyara, canke gufatwa n’indwara y’umusonga).
2. Ububabare bukomeye butunguranye bwo mu gikiriza co hasi / mu gifu co hejuru (kenshi bushika mu mugongo w’ibubamfu canke ku rutugu rw’ibubamfu biciye ku mutsi w’imbere).
3. Emphysema yo munsi y’urukoba (Cervical Crepitus) mu ijosi no mu mfuruka y’izosi: Umuyaga umira unyura mu mwobo wo hasi w’umuhogo ugenda uja hejuru ukurikije indege z’imitsi y’umubiri (fascial plans) zija mu mutwe w’izosi, aho ushobora kwumva uriko uratera nk’igipfukisho c’ibibumbano munsi y’intoke zawe.

Clinical caveat: Naho ubutatu bwa Mackler bushobora gutera indwara (bushobora gupima 100 kw’ijana iyo buriho), ivyo bihimba vyose bitatu bigaragara hamwe igihe umuntu abanza kuvyerekana ku barwayi 15 gushika ku 30 kw’ijana gusa kuko umuyaga ushobora gutwara amasaha 1 gushika ku 6 kugira ngo unyure mu ruhu rwo hasi gushika mu ijosi. Ntukigere wirengagiza indwara ya Boerhaave kubera gusa ko igihimba c’izosi c’umubiri (neck crepitus) kitaraboneka.

2. Ubutatu bwa Anderson n'ikimenyetso ca Hamman ("Igitero co hagati")¶

• Ubutatu bwa Anderson: Emphysème yo munsi y’urukoba + Guhema vuba cane (tachypnea) + Gukomantara mu nda (biterwa n’ugushavura kw’igihimba c’umubiri n’igihimba co hejuru c’igihimba c’umubiri cigana igisebe c’inda gitoboye).
• Ikimenyetso ca Hamman (Mediastinal Crunch): Iyo umuganga canke umuganga yumvirije hejuru y’imbere y’umutima (precordium) akoresheje igikoresho co kwumviriza mu gihe umurwayi aryamye ku ruhande rwiwe rw’ibubamfu, umutima wose utera utanga ijwi rirenga **ry’ugutera, ry’ugukanda, ry’ugutera, canke ry’ugutera ry’umutima rihuye n’ijwi ry’umutima ry’ugutera ry’umutima (a umutima upfutse ku mubiri imifuko y’umuyaga ifunzwe imbere mu gice c’umubiri citwa mediastinum.
• Ihinduka ry'Ijwi ("Rhinolalia" canke "Donald Duck / Brass Voice"): Uko umuyaga wo hagati mu muhogo uca uja hejuru mu bibanza vy'inyuma n'inyuma y'umuhogo, ijwi ry'umurwayi rifata bukwi na bukwi ijwi ry'agatangaza, ry'ijwi rirenga, ry'amazuru, ry'inzoka ry'inzoka ry'inzoka.

Kubera iki gufata amashusho mu bitaro bitegerezwa gukoresha ubuhinga bwo gupima amazi (Gastrografin) be n’ubuhinga bwo gupima amazi (Barium) hakiri kare¶

Kubera ko imishwarara y’igifu ishobora gusa n’iyisanzwe mu masaha 1 canke 3 ya mbere imbere y’uko yerekana imirongo y’umuyaga yo hagati mu gifu (ikimenyetso ca V ca Naclerio ku rubibi rwo hasi rw’ibubamfu rw’umutima), ivyiyumviro vy’ugusohoka kw’amazi mu gifu c’ibubamfu, canke ivyiyumviro vy’ugusohoka kw’amaraso mu gifu, **World Society of Emergency Surgery) amasezerano:

1. Ikigeragezo c'Inzahabu: CT Esophagogram ikoresheje ubuhinga bwo gutandukanya ibintu n'ibindi bikoresho vyo mu kanwa bishobora gusenyuka mu mazi¶

Iyo umurwayi ari maso kandi ashobora kumira kugira ngo asuzumwe imbere mu gikoresho co gupima umubiri (canke biciye ku nzira y’amazi y’umuhogo (nasoesophageal tube) ishizweho n’umuhinga yitonze cane): - Abaganga batanga Ikintu co gupima umubiri gifise iyode gishobora gusenyuka mu mazi (nk’igiti citwa Gastrografin / diatrizoate meglumine) ubwo nyene imbere y’uko bakora Ipima ry’umubiri ry’igifu. - Ico gipimo ca CT gifise ubushobozi bwo gutahura 92 gushika ku 100 kw’ijana, kigaca kigaragaza utuvungukira dutoduto tw’umuyaga wo hanze y’umuhogo, ugukomera kw’uruhome rw’umuhogo, amazi yo mu muhogo akoranira hamwe, n’umuyaga w’umweru ukeye w’ibitandukanye biva mu gice c’inyuma c’umuhogo canke mu muhogo w’inyuma w’umuhogo.

2. Kubera iki Barium Sulfate ibujijwe cane nk’ikigeragezo ca mbere co gutandukanya¶

3. Igikoresho co gupima igifu (Amylase y'amazi yo mu maraso na pH)¶

Iyo abaganga bashize umuyoboro wo mu gikiriza mu gifu c’ibubamfu c’umurwayi wa Boerhaave, ayo mazi asohoka akenshi aranuka nk’ayo mu nda, arimwo ibintu vy’ibifungurwa, afise pH y’aside iri munsi ya 6,0, kandi afise urugero rw’amacandwe rwitwa amylase y’amacandwe n’amazi y’amacandwe, ivyo bikaba bigaragaza ko

Ubuvuzi bw’ibitaro butomoye: idirisha ryo kubagwa ry’amasaha 24, stents zikoreshwa mu mubiri, na EndoVAC¶

Iyo indwara ya Boerhaave imaze gutorwa mu kigo c’ubuvuzi bw’ibihe vyihutirwa, umugwi w’ibitaro uca utanguza Igikorwa co gusubiza ubuzima mu mubiri WSES / AATS:

1. NPO ikomeye + Nasogastric Compression: Ishirwako neza (kenshi munsi y’ivyo umuntu abona mu nda) kugira ngo ikure aside mu nda.
2. Imiti igabanya ububabare bw’umubiri (Pantoprazole canke Esomeprazole IV): Itera pH y’igifu hejuru ya 6,0 kugira ngo aside y’amazi na pepsine ntibishire mu mubiri.
3. Imiti igabanya ubukana bw’indwara y’ibicurane: Bitandukanye n’ibitobo vyo mu mara yo hasi, ibitobo vyo mu nzira y’amaraso kenshi bifise ubwoko bwa **Candida buva mu kanwa no mu nzira y’amaraso (na cane cane ku barwayi bafata imiti igabanya aside, steroids, canke alubcoholated). Amabwirizwa asaba ko umuntu yofata imiti igabanya ubukana bw’indwara (piperacillin-tazobactam canke carbapenem [meropenem] + vancomycine) UKONGERAKO n’imiti igabanya ubukana bw’indwara y’ibicurane (micafungin/caspofungin).
4. Gufunga no gukura amazi mu mfuruka (Mu gihe c' <24-Hour Idirisha ry'inzahabu):
5. Ugusanura kw’ibanze (Thoracotomy canke Thoracoscopie / Laparoscopie y’ubuhinga bukeyi): Igitigiri c’amateka c’inzahabu ku barwayi bafise amagara meza bafise ubuhumane bw’igifu butagiramwo ububabare. Umuganga w’igifu afungura igifu c’ibubamfu, akayoza ivyokurya vyose, aside, n’ibisebe biva mu gice co hagati n’igihimba c’umubiri, akagabanya imirongo y’ibihimba vy’umubiri n’imitsi kugira ngo yerekane uburebure bwose bw’amarira y’umubiri (ari yo yama ari maremare kuruta amarira y’imitsi yo hanze), agadoda imitsi y’inyuma n’imitsi ibiri, vascularized flap y’imitsi iri hagati y’ibibero, igihimba c’umubiri, igihimba c’umubiri, canke igihimba c’umubiri co mu nda (Thal/Dor patch) hejuru y’umurongo w’urudodo kugira ngo ntiyigere imeneka, igasiga imirongo yagutse y’igifu kugira ngo amazi asohoke.
6. Igikoresho co mu maraso gipfutse (SEMS) canke igikoresho co mu maraso gipfutse (OTSC): Ku marira mato mato yafashwe kare imbere y’uko indwara y’ibihaha ikwiragira, canke ku barwayi bafise intege nke, abaganga bavura indwara z’ibihaha canke abaganga babaga igifu bashiramwo igikoresho co mu gifu gishobora gukurwako. imbere, bifatanijwe n’amazi asohoka mu gikiriza biciye mu ruhu.
7. Ugufunga bifashijwe n’ubusa (EndoVAC / EVT): Iterambere rikomeye ry’ubuhinga bwa none ku bijanye n’ugucika kw’umuhogo mu gihe c’imbere n’igihe (>amasaha 24). Igiponji c’ipolyurethane gifatanye n’uruzitiro rwo kunyonga rwo mu nda gishirwa mu buryo bw’ubuhinga bwa endoscope ata guca ku ruhande canke hejuru y’ico kinogo c’ugutobora hakoreshejwe umukazo w’ubusa uguma utari mwiza (-125 mmHg), gukomeza kunyonga ibivyimba biva mu gice c’umubiri citwa mediastinum mu gihe bisenya umwobo kandi bikavyura ugukira kw’ibihimba vy’umubiri vyihuta, bikaba bishika ku 85 gushika ku 95 kw’ijana vy’ugufunga.

Ibintu bishobora gutera ingorane nyinshi n'ukudaruha bitera gucika kw'umuhogo¶

Naho gukorora ku nguvu inyuma yo kurya cane canke kunywa inzoga ari vyo bituma abantu benshi barwara indwara ya Boerhaave, abaganga na bo nyene bararaba ibintu vyinshi bidasanzwe bitera iyo ndwara aho umuvuduko wo mu muhogo utera bukwi na bukwi ku gice co hejuru c’umubiri gipfutse:

• Hyperemesis gravidarum ikaze cane, gutakaza imiti, canke gufunga amara: Abarwayi bafise ibihe vy’ugutera ivyatsi vyumye mu masaha menshi barashobora kuva ku gukomeretsa gutoyi kw’umubiri wa Mallory-Weiss gushika ku gusenyuka kw’umubiri wuzuye kwa Boerhaave iyo imiti igabanya ububabare itevye.
• Kunywa vuba amazi menshi afise gaze canke polyethylene glycol bowel prep: Kunywa amalita y’amazi yo gutegura colonoscopy vuba hanyuma ugaca uvyuka ku nguvu ku nda yagutse ni ikintu gikomeye c’ibitaro gitera umuhogo guca.
• Imigenderanire ya Valsalva ikaze cane ata n’umwe arutse: Gake cane, ugucika kw’umuhogo kw’umuhogo (barogenic esophageal rupture) kubaho mu gihe umuntu ariko araterura ibintu bikomeye (uguterura ibintu bikomeye canke gutera imbere afise ururimi rwugarijwe), gukorora cane, status asthmaticus, gukorora cane, canke gukorora cane. Igihe cose muri ivyo bintu bikurikiwe n’ububabare butunguranye bwo gutabura inyuma y’igihimba c’irondoka n’ugucika intege kw’izosi, muvure umurwayi mu buryo bumwe nyene bukomeye bwa NPO n’uburyo bwo gutwara abantu mu buryo bwihutirwa.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Umuntu akekwa ko afise indwara ya Boerhaave asaba ko ahita atwara imodoka itwara abarwayi mu bitaro vy’amashure yisumbuye afise amasaha 24 y’ugupima CT, kubagwa mu gikiriza canke mu gifu co hejuru, kubagwa mu gifu, no kwivuza cane:

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911. Gusaba gutwara umuntu mu bitaro bikuru vy’ubuvuzi vyihutirwa (ntiwigere uba ivuriro ry’ubuvuzi bwihutirwa ryigenga).
• Ubwongereza: Hamagara kuri 999 kugira ngo ubone imodoka y’ubuvuzi bw’ivyihutirwa y’urugero rwa ½ ija mu bitaro bikomeye vy’ubuvuzi bw’indwara zikomeye Igisata c’ubuvuzi bw’ivyihutirwa (A&E) gifise igisata c’ubuvuzi bw’ibihimba vy’irondoka (Upper-GI / Oesophagogastric Surgical).
• Ubumwe bw'Uburaya: Hamagara 112. Irongowe hakurikijwe Ishirahamwe ry’Isi ry’Ivy’Ukubaga Ivyihutirwa (WSES) Amabwirizwa y’Ivy’Ivyihutirwa vyo mu Muhogo n’amategeko Ishirahamwe ry’Uburaya ry’Ivy’Imitsi y’Igifu (ESGE).
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande.
• Ubuhindi na Aziya-Pasifike: Hamagara 112 (canke 108 mu Buhindi), 995 muri Singapore, 119 mu Buyapani na Koreya y’Epfo, canke 999 muri Maleziya na Hong Kong. Gusaba ikigo c’amashure yisumbuye gifise ubushobozi bwo kubaga umutima canke kubaga indwara z’ibihaha.

Ibibazo bikunda kubazwa¶

Ni kubera iki ari akaga guhagarika canke gupfukamira umuntu ku nguvu?¶

Iyo umubiri wawe uvyuriye umutima wo guruka, imitsi yawe y’umubiri n’iy’inda irafatanya n’inkomezi zikomeye cane kugira ngo ikure ibiri mu nda hejuru mu gihe umutsi wo hejuru w’umuhogo uri hejuru y’umuhogo wawe wiruhutsa kugira ngo ureke iyo nda isohoke. Iyo upfutse akanwa kawe n’umuhogo wawe kugira ngo nturuke mu ruhame, uwo muvumba w’amazi n’umuyagankuba ufise umuvuduko munini utera urugi rwugarijwe hejuru y’umuhogo, ugatuma umuvuduko wo mu muhogo wo hasi urenga 200 mmHg maze ugafuha umwobo w’umuhogo wuzuye uca mu gikiriza cawe co hasi.

Ni kuki umuntu akekwa ko afise indwara ya Boerhaave adashobora kunywa n’agace k’amazi amaze guruka?¶

Mu ndwara ya Boerhaave, hariho umwobo wuguruye uca mu ruhome rw’umuhogo wo hasi uja mu gice c’umubiri citwa sterile mediastinum (ikikuje umutima) no mu kibanza c’ibubamfu c’amahaha (ikikuje amahaha y’ibubamfu). Igihe cose uwo muntu anywa amazi, ginger ale canke umuti wo gukingira aside, uca asuka ugororotse biciye muri uwo mwobo ukaja mu mfuruka y’igikiriza ciwe, ukajana n’imigera amamiliyoni yo mu kanwa kandi ugatuma umuntu yihuta gufatwa n’indwara y’amahaha n’ugusenyuka kw’amahaha. Iyo akanwa karyoshe amaze guruka, uwo muntu yoshobora gukaraba akanwa kiwe n’amazi yitonze maze akayasuka 100 kw’ijana mu gikarabiro ata n’itonde rimwe amira.

None ubutatu bwa Mackler mu ndwara ya Boerhaave ni ubuhe?¶

Ubutatu bwa Mackler ni igitabu ca kera gifise ibimenyetso bitatu vyerekana ko umuntu afise umuhogo wacitse: (1) gukorora canke gukorora cane, hanyuma ugaca ugira (2) ububabare butunguranye, bubabaza cane mu gikiriza co hasi canke mu nda yo hejuru, be n’(3) ububabare bwo mu gikiriza bwo munsi y’urukoba n’ububabare bwo mu mutwe ( amagufa y’ibirenge apfutse kandi akavuza nk’i Rice Krispies canke bubble wrap iyo umuntu akozweko buhoro buhoro n’intoke). Kubera ko bishobora gutwara amasaha 1 gushika ku 6 kugira ngo umuyaga uva mu gikiriza uduge mu rukoba rw’izosi, utegerezwa guhamagara abajejwe ivy’ubuvuzi vyihutirwa ubwo nyene kubera ububabare bukomeye bwo mu gikiriza inyuma yo gukorora naho nyene ugusenyuka kw’izosi kutagaragara.

Ni gute indwara ya Boerhaave itandukanye n’amarira ya Mallory-Weiss?¶

Ivyo bibazo vyose biterwa n’ugusubira inyuma canke gukorora ku nguvu, ni co gituma akenshi bitera urujijo. Amarira ya Mallory-Weiss ni gusa igikomere gitoya cane kiri mu gice c’imbere c’umubiri aho umuhogo uhurira n’inda; uruhome rw’imitsi rwo hanze ruguma rudakomeretse rwose, ku buryo ata kintu na kimwe kiva mu gikiriza, ububabare buraba buke canke butabaho, ikimenyetso nyamukuru ni uguruka imirongo y’amaraso itukura cane, kandi 90 kw’ijana birakira ubwavyo mu misi mikeyi. Indwara ya Boerhaave ni uguhuha kw’umubiri wose biciye mu bice vyose vy’uruhome rw’umuhogo bikaja mu mfuruka y’igikiriza; bitera ububabare bwo gutabura 10/10 mu gikiriza no mu mugongo, guhumeka nabi, no guhungabana vyihuta, kenshi amaraso make canke nta maraso ari make mu vyo atera, kandi bisaba ko umuntu abagwa vyihutirwa canke akoresheje endoscope kugira ngo ashobore kurokoka.

Ni kubera iki indwara ya Boerhaave ikunda gufatwa nabi mu masaha makeyi ya mbere?¶

Kubera ko indwara ya Boerhaave igaragaza ububabare butunguranye bwo gutabura mu gikiriza, ububabare bwo mu mugongo, guhumeka nabi, gucuya, n’umuvuduko w’amaraso muto, abaganga n’abaganga mu ntango biyumvira ibintu vyihutirwa cane bikunze gushika mu gikiriza nk’indwara y’umutima (infarctus myocardique), ugutabuka kw’umutsi w’amaraso (aorte dimonaire). embolism), igisebe co mu nda gitoboye, canke indwara y’amafyigo ikaze cane. Kubwira umuforoma n’umuganga w’ivy’ugutoranya neza yuko ububabare bwo mu gikiriza bwateye mu gihe nyaco c’ugutera hejuru canke gukorora ni co kintu nyamukuru gituma umuntu ahita akora CT esophagogram.

Ni kuki ubuzima bugabanuka cane iyo indwara ya Boerhaave itavuwe mu masaha 24?¶

Iyo umuntu asuzumye umuhogo wacitse maze akawusanura (canke akawufunga n’igikoresho citwa endoscopic stent canke vacuum sponge) mu masaha 12 gushika kuri 24 ya mbere, imirongo y’imitsi y’umuhogo iracari nziza kandi ifata neza imidodo, ivyo bikaba bituma umuntu ashobora kurokoka ku rugero rwa 85 gushika ku 90+ kw’ijana. Inyuma y’amasaha 24 gushika kuri 48 umuntu yinjije mu aside yo mu nda, mu bihimba vy’umubiri bifasha mu gufata ibiribwa, no mu migera yo mu kanwa, imirongo y’umuhogo iravyimba, igapfa, kandi igaca imeneka nk’impapuro z’ibihimba vy’umubiri zitose (ntizishobora gufata imidogo), mu gihe ububabare bw’imigera myinshi bushobora gutuma umuntu agira ububabare bwinshi (polymicrobial mediastinitis and septic shock to40).

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe mpuzamakungu ry’abaganga b’ibihe vyihutirwa (WSES, Mpuzamakungu): Ibibazo vyihutirwa vy’umuhogo: Amabwirizwa ya WSES (Chirica n’abandi, Ikinyamakuru c’isi yose c’abaganga b’ibihe vyihutirwa, inzira yo gupima CT esophagogram ishobora gusenyuka mu mazi, gukingira imigera n’ibicurane, <24-hour gusanura mu kubaga n’ugutera stent mu mubiri n’ubuvuzi bwa EndoVAC).
• Ishirahamwe ry’Uburayi ry’Ivyuma vy’Inda (ESGE, Europe): Ingingo ngenderwako y’ESGE ku Gupima no Gucungera Ivyiyumviro vy’Inda (Harimwo n’Indwara ya Boerhaave, Stents z’Ivyuma Zipfutse, OTSC, n’Ubuvuzi bw’Ivyuma Bipfutse).
• Ishirahamwe ry’Abanyamerika ry’Abaganga babaga Igifu (AATS) & Ishirahamwe ry’Abaganga Babaga Igifu (STS, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako z’abahinga ku bijanye no gufasha umuntu gutoboka mu muhogo n’indwara y’umuhogo ikomeye.
• Ishure ryisumbuye ry’Amerika ry’Ivy’Inda (ACG, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako z’ubuvuzi ku bijanye no gucungera amaraso ava mu nda yo hejuru, indwara ya Mallory-Weiss, n’Ibikomere vyo mu nda biterwa n’indwara y’ibihaha.
• Ikigo c'Igihugu c'Ubuzima n'Ukwitwararika (NICE) & Ishirahamwe ry'abaganga bo mu nda zo hejuru ry'Ubwongereza na Irlande (AUGIS, Ubwongereza): Ivyiyumviro vy'ubuvuzi vyihutirwa vy'ugutoboka kw'insogi (Boerhaave Syndrome).

Inyobora zifitaniye isano¶

• Kuva amaraso mu nda, gutakaza amaraso (hematemesis), n’indwara ya melena .
• Imitsi y’umuhogo imeneka, amaraso ava mu ndwara ya cirrhose, n’indwara y’ubwonko y’igitigu
• Igufa ry'ifi ryamizwe, igufa ry'inkoko, n'ingaruka z'ibifungurwa vyo mu muhogo
• Kunyosha igikomere co mu gikiriza no guhagarika umutima pneumothorax ubutabazi bwa mbere
• Gucagura umutsi w'amaraso n'ugucagura umutsi w'amaraso wo mu nda