Detailed Treatment Process
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Gastroscopy Report Gender: Male Age: 93 years Department: Gastroenterology Endoscopic Findings: Esophageal mucosa was normal in color, with clear and regular submucosal vascular pattern. The Z-line was clear, and the cardia mucosa and morphology were normal. Large amounts of retained material were present in the gastric fundus and body; the visible mucosa and morphology were normal. The gastric angle was arched, with no ulcers or neoplastic lesions seen. An ulcer approximately 3 × 3 cm was noted on the anterior wall of the greater curvature of the gastric antrum. The base was relatively deep, with surrounding mucosal congestion and elevation. One biopsy was taken. Pyloric obstruction was present. Diagnosis: Ulcerative carcinoma of the gastric antrum, possibly with pyloric obstruction. Biopsy site: Gastric antrum Report date: April 18
The patient died during gastric stent placement. The outpatient medical record documented the process, but most of the handwritten notes were illegible. The legible portions are as follows: Page 22 (upper half) Date: April 21 Department: Endoscopy Emergency History of present illness: History of gastric disease. Due to “pyloric obstruction caused by gastric cancer,” … endoscopic (stent placement). Preoperative preparation: After consideration by the patient’s family, the patient was admitted to the endoscopy center. Risk disclosure: After discussion, the risks were deemed high, including possible placement failure, perforation, etc. The patient’s family indicated they understood and accepted the risks. Procedure record: This morning, “pyloric stent placement” was performed at the endoscopy center. Intraoperative findings: Endoscopy showed pyloric stenosis. The patient cooperated well, but during the procedure … (handwriting blurred here) Vital signs changes: The patient developed vomiting, loss of consciousness, and electrocardiographic monitoring showed a decrease in heart rate … Page 23 (lower half) Procedure termination: Because the patient’s condition could not tolerate continuation, pyloric stent placement was abandoned. Physical examination record: Vital signs monitoring: BP 150/80 mmHg, SpO₂ 10% (extremely low oxygen saturation), HR 60 beats/min. Follow-up recommendations: Considering the patient’s advanced age and poor general condition due to disease progression, it is recommended that the family … (handwriting blurred here) provide symptomatic supportive treatment.
Family’s recollection afterward 1. During the gastric stent placement in the outpatient procedure room, the family heard the patient groaning loudly through the door crack. 2. After the placement failed, the patient was transferred to the observation room. At that time, the patient felt cold.