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Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report.

Takami Y, Koh T, Nishio M, Nakagawa N - World J Emerg Surg (2011)

Bottom Line: Pneumatosis intestinalis (PI) is an uncommon disorder defined as multiple foci of gas within the intestinal wall.Despite recognition of an increasing number of cases of PI, the optimal management strategy, whether through surgical or other means, remains controversial.The present report describes the case of a patient with PI who underwent exploratory laparotomy without specific findings and who ultimately died due to extensive intestinal hemorrhage that was possibly triggered by surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Social Insurance Kobe Central Hospital, 2-1-1, Sohyama-cho, Kita-ku, Kobe City 651-1145, Japan. yukakotakami@yahoo.co.jp.

ABSTRACT
Pneumatosis intestinalis (PI) is an uncommon disorder defined as multiple foci of gas within the intestinal wall. Despite recognition of an increasing number of cases of PI, the optimal management strategy, whether through surgical or other means, remains controversial. The present report describes the case of a patient with PI who underwent exploratory laparotomy without specific findings and who ultimately died due to extensive intestinal hemorrhage that was possibly triggered by surgery.

No MeSH data available.


Related in: MedlinePlus

CT. Abdominal CT reveals diffuse intramural gas from the ascending colon to the transverse colon and a large amount of free air in the abdominal cavity without portal venous air or extraluminal fluid collections. This study shows diffuse pneumoperitoneum, which led us to suspect the presence of gastrointestinal perforation. Portal venous gas, which frequently follows severe pneumatosis intestinalis, is also absent.
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Figure 1: CT. Abdominal CT reveals diffuse intramural gas from the ascending colon to the transverse colon and a large amount of free air in the abdominal cavity without portal venous air or extraluminal fluid collections. This study shows diffuse pneumoperitoneum, which led us to suspect the presence of gastrointestinal perforation. Portal venous gas, which frequently follows severe pneumatosis intestinalis, is also absent.

Mentions: An 81-year-old female nursing home resident presented to our Emergency Department with hematochezia. Past medical history included appendectomy, atrial fibrillation treated with cibenzoline, an 11-year history of rheumatoid arthritis treated with prednisone at 5 mg/day, prior cerebral infarction with ongoing treatment with cilostazol at 200 mg/day, and a percutaneous endoscopic gastrostomy (PEG) established 1 year previously. On arrival, the patient did not show severe status on physical examination and vital signs were within normal limits, including a blood pressure of 130/80 mmHg. Abdominal examination only revealed abdominal distention and mild tenderness in the right upper quadrant, without guarding or rebound tenderness. Bloody stools were observed in her diaper. Noteworthy findings from laboratory evaluation comprised only an elevated white blood cell count (WBC) of 10.6 ×103/μL and mildly elevated C-reactive protein of 1.6 mg/dL. No anemia was apparent, hematocrit was 41.9% and hemoglobin level was 13.5 g/dL. However, computed tomography (CT) revealed diffuse intramural gas from the ascending colon to the transverse colon and a large amount of free air in the abdominal cavity without portal venous air, extraluminal fluid collections or any specific signs indicating ileus or mesenteric artery occlusion (Figure 1). Upper gastrointestinal (GI) endoscopy showed no evidence of perforation in the upper GI tract. Arterial blood gas analysis showed: pH, 7.38; bicarbonate, 24.3 mmol/L; and WBC increased to 11.8 ×103/μL.


Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report.

Takami Y, Koh T, Nishio M, Nakagawa N - World J Emerg Surg (2011)

CT. Abdominal CT reveals diffuse intramural gas from the ascending colon to the transverse colon and a large amount of free air in the abdominal cavity without portal venous air or extraluminal fluid collections. This study shows diffuse pneumoperitoneum, which led us to suspect the presence of gastrointestinal perforation. Portal venous gas, which frequently follows severe pneumatosis intestinalis, is also absent.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108289&req=5

Figure 1: CT. Abdominal CT reveals diffuse intramural gas from the ascending colon to the transverse colon and a large amount of free air in the abdominal cavity without portal venous air or extraluminal fluid collections. This study shows diffuse pneumoperitoneum, which led us to suspect the presence of gastrointestinal perforation. Portal venous gas, which frequently follows severe pneumatosis intestinalis, is also absent.
Mentions: An 81-year-old female nursing home resident presented to our Emergency Department with hematochezia. Past medical history included appendectomy, atrial fibrillation treated with cibenzoline, an 11-year history of rheumatoid arthritis treated with prednisone at 5 mg/day, prior cerebral infarction with ongoing treatment with cilostazol at 200 mg/day, and a percutaneous endoscopic gastrostomy (PEG) established 1 year previously. On arrival, the patient did not show severe status on physical examination and vital signs were within normal limits, including a blood pressure of 130/80 mmHg. Abdominal examination only revealed abdominal distention and mild tenderness in the right upper quadrant, without guarding or rebound tenderness. Bloody stools were observed in her diaper. Noteworthy findings from laboratory evaluation comprised only an elevated white blood cell count (WBC) of 10.6 ×103/μL and mildly elevated C-reactive protein of 1.6 mg/dL. No anemia was apparent, hematocrit was 41.9% and hemoglobin level was 13.5 g/dL. However, computed tomography (CT) revealed diffuse intramural gas from the ascending colon to the transverse colon and a large amount of free air in the abdominal cavity without portal venous air, extraluminal fluid collections or any specific signs indicating ileus or mesenteric artery occlusion (Figure 1). Upper gastrointestinal (GI) endoscopy showed no evidence of perforation in the upper GI tract. Arterial blood gas analysis showed: pH, 7.38; bicarbonate, 24.3 mmol/L; and WBC increased to 11.8 ×103/μL.

Bottom Line: Pneumatosis intestinalis (PI) is an uncommon disorder defined as multiple foci of gas within the intestinal wall.Despite recognition of an increasing number of cases of PI, the optimal management strategy, whether through surgical or other means, remains controversial.The present report describes the case of a patient with PI who underwent exploratory laparotomy without specific findings and who ultimately died due to extensive intestinal hemorrhage that was possibly triggered by surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Social Insurance Kobe Central Hospital, 2-1-1, Sohyama-cho, Kita-ku, Kobe City 651-1145, Japan. yukakotakami@yahoo.co.jp.

ABSTRACT
Pneumatosis intestinalis (PI) is an uncommon disorder defined as multiple foci of gas within the intestinal wall. Despite recognition of an increasing number of cases of PI, the optimal management strategy, whether through surgical or other means, remains controversial. The present report describes the case of a patient with PI who underwent exploratory laparotomy without specific findings and who ultimately died due to extensive intestinal hemorrhage that was possibly triggered by surgery.

No MeSH data available.


Related in: MedlinePlus