پارگی درجه پنج کبد به دنبال احیای قلبی ریوی: گزارش موردی

زمینه و هدف: احیای قلبی-‌ریوی یک درمان نجات‌دهنده برای ایست قلبی می‌باشد، در این مطالعه بیمار با پارگی کبد به‌دنبال احیای قلبی ریوی گزارش می‌گردد.معرفی بیمار: بیمار خانم 76 ساله، با درد شکم که از یک هفته شروع شده، در دی 1402، به اورژانس بیمارستان امام‌علی (ع) بجنورد مراجعه کرده است. معاینه مطرح‌کننده شوک و پریتونیت بود. در گرافی قفسه‌سینه هوای آزاد شکم گزارش شد. شکم با برش میدلاین باز شد، باتوجه به گانگرن روده باریک، رزکسیون و ایلئوستومی انجام شد. به علت ارست قبلی بیمار، در انتهای جراحی احیای قلبی شروع شد. پس از شروع ماساژ بیمار دچار پارگی کبد شدکه با پک کردن متوقف شد و احیا ادامه پیدا کرد ولی متاسفانه بیمار فوت نمود.نتیجه‌گیری: از عوارض نادر احیای‌ قلبی آسیب احشا مخصوصا پارگی کبد می‌باشد. با توجه به اینکه علائم آن با بیمار قلبی مشترک می‌باشد، تشخیص آن دشوار بوده و درصد مرگ‌ومیر بالایی دارد. 

grade five liver laceration following cardiopulmonary resuscitation: a case report

background: cardiopulmonary resuscitation (cpr) is a potentially life-saving treatment for cardiac arrest but puts the subject at risk for iatrogenic skeletal and soft tissue injuries including the liver. in this study, an elderly patient with grade 5 liver rupture after cardiopulmonary resuscitation following laparotomy is reported.case presentation: a 76-year-old female patient with diffuse abdominal pain that started a week ago and worsened since 2 days ago in the winter of 2024, referred to the emergency room of imam ali bojnurd hospital. in the examination, the patient met the criteria for shock. abdominal examination revealed peritonitis. after initial resuscitation and stabilization of the patient’s condition, an x-ray was performed for the patient. according to the standing chest x-ray, pneumoperitoneum report, the patient underwent surgery with midline incision. in the performed surgery, evidence of gangrene and perforated was evident in a part of the small intestine, and the patient is a candidate for resection of the gangrenous and perforated intestinal segment, and then the two proximal and distal ends of the resected area were removed as an ileostomy from the right side of the abdomen. at the end of surgery, before closing the abdominal wall, the patient suffered a cardiac arrest, and cpr was started for the patient in operation room. after starting the chest massage, the patient suffered a grade 5 liver tear, the bleeding of the liver was stopped by packing with four large abdominal pads and cpr continued for 45 min, but unfortunately the patient died.conclusion: one of the rare complications of cardiopulmonary resuscitation and chest massage is visceral damage, including liver rupture. considering that its symptoms are similar to cardiac arrest, it is difficult to diagnose in case of rupture and has a high mortality rate. according to the reports of liver and visceral damage after cpr, some studies have recommended the use of focused assessment with sonography for trauma (fast) to detect visceral damage after cpr.