An alternative method to differentiate pleural effusion after leakage of artificial enteral nutrition formula.

IF 1.5 4区 医学 Q2 MEDICINE, LEGAL
Fabian Picht, Karen Blümke-Anbau, Carolin Richter, Marco Weber
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引用次数: 0

Abstract

Purpose: This case report highlights a rare but fatal complication of artificial enteral nutrition due to feeding tube misplacement, leading to pleural effusion and respiratory failure. The primary objective was to determine whether enteral nutrition formula leakage contributed to the patient's death and to differentiate the pleural effusion from other possible etiologies, such as chylothorax.

Methods: A 59-year-old male patient with severe lung disease underwent left-sided partial lung resection and subsequently received enteral nutrition via a nasogastric feeding tube. After suspected feeding tube misplacement and formula leakage into the pleural cavity, autopsy and histological examination were performed. Cytological and chemical analyses, including gas chromatography-mass spectrometry, were employed to identify nutritional components in pleural effusion and to confirm the presence of enteral nutrition formula.

Results: The autopsy revealed milky, turbid pleural effusion, aspiration pneumonia, and a rupture of the right visceral pleura. Cytological analysis confirmed granulocytic pleural empyema with rod-shaped Congo red-positive material resembling the enteral nutrition formula. Gas chromatography-mass spectrometry identified tricaprylin, a unique marker for enteral nutrition formula, confirming nutritional leakage into the pleural cavity.

Conclusions: This case study emphasizes the necessity for radiological confirmation of feeding tube placement and the implementation of comprehensive diagnostic protocols for suspected cases of nutritional fluid leakage. Gas chromatography-mass spectrometry proved invaluable in distinguishing nutritional effusions from other potential etiologies by enabling the specific identification of enteral formula components. The high specificity and adaptability of gas chromatography-mass spectrometry render it an essential tool for forensic investigations and clinical diagnostics involving complex fluid analyses, facilitating evidence-based conclusions in critical care and postmortem contexts.

目的:本病例报告强调了一种罕见但致命的人工肠内营养并发症,其原因是喂食管错位,导致胸腔积液和呼吸衰竭。主要目的是确定肠内营养配方泄漏是否导致患者死亡,并将胸腔积液与其他可能的病因(如乳糜胸)进行鉴别:一名患有严重肺病的 59 岁男性患者接受了左侧部分肺切除术,随后通过鼻胃喂养管接受肠内营养。在怀疑喂食管错位和配方奶漏入胸膜腔后,进行了尸检和组织学检查。采用细胞学和化学分析(包括气相色谱-质谱法)确定胸腔积液中的营养成分,并确认存在肠内营养配方:尸体解剖发现乳白色浑浊胸腔积液、吸入性肺炎和右侧内脏胸膜破裂。细胞学分析证实了粒细胞性胸膜积液,其中棒状刚果红阳性物质与肠内营养配方相似。气相色谱-质谱法鉴定出了肠内营养配方的独特标记物--三胰蛋白酶,证实了营养物质渗入胸膜腔:本病例研究强调了对喂食管放置进行放射学确认的必要性,以及对疑似营养液渗漏病例实施综合诊断方案的必要性。事实证明,气相色谱-质谱联用技术在区分营养性渗出和其他潜在病因方面非常有价值,它能对肠道配方成分进行特异性鉴定。气相色谱-质谱法的高度特异性和适应性使其成为涉及复杂液体分析的法医调查和临床诊断的重要工具,有助于在重症监护和尸检中得出以证据为基础的结论。
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来源期刊
Forensic Science, Medicine and Pathology
Forensic Science, Medicine and Pathology MEDICINE, LEGAL-PATHOLOGY
CiteScore
3.90
自引率
5.60%
发文量
114
审稿时长
6-12 weeks
期刊介绍: Forensic Science, Medicine and Pathology encompasses all aspects of modern day forensics, equally applying to children or adults, either living or the deceased. This includes forensic science, medicine, nursing, and pathology, as well as toxicology, human identification, mass disasters/mass war graves, profiling, imaging, policing, wound assessment, sexual assault, anthropology, archeology, forensic search, entomology, botany, biology, veterinary pathology, and DNA. Forensic Science, Medicine, and Pathology presents a balance of forensic research and reviews from around the world to reflect modern advances through peer-reviewed papers, short communications, meeting proceedings and case reports.
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