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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

Intraoperative findings. Intraoperatively, macroscopic examination of the abdominal cavity shows multiple subserosal bubbles with a diameter of 1-2 mm, mainly around the transverse colon. The appearance of these cystic bubbles is compatible with the characteristics of pneumatosis intestinalis.
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Figure 2: Intraoperative findings. Intraoperatively, macroscopic examination of the abdominal cavity shows multiple subserosal bubbles with a diameter of 1-2 mm, mainly around the transverse colon. The appearance of these cystic bubbles is compatible with the characteristics of pneumatosis intestinalis.

Mentions: Persistence of abdominal symptoms, absence of upper GI perforation, and results from CT strongly suggested lower intestinal perforation and consequent intestinal necrosis. We therefore decided to perform emergent laparotomy. At the beginning of the operation, vital signs remained stable. Observation of the abdominal cavity found no hydroperitoneum, but intraabdominal tissues appeared friable and hemorrhagic. Although the intestine was explored very carefully from the ligament of Treitz to the pouch of Douglas, no indications of gross perforation, ischemia, or tumor were identified. However, multiple subserosal bubbles (diameter, 1-2 mm) were observed, mainly around the transverse colon (Figure 2). During these procedures, the spleen was slightly injured. Although the injury itself was only slight and easy to repair immediately using pressure with oxidized cellulose (Surgicel), bleeding appeared to continue and total blood loss was estimated at 730 mL. Blood pressure decreased to 65/43 mmHg. Hemoglobin and hematocrit decreased markedly to 4.8 g/dL and 15.3%, respectively. Without any gross detection of intestinal perforation, exploratory laparotomy was completed with placement of two Penrose drains within the abdominal cavity, at which point total blood loss was estimated at 1100 mL. Blood pressure was 58/33 mmHg, heart rate was 67 beats/min, and body temperature was 32.9°C. Despite all resuscitation measures including transfusion, the patient died of hypovolemic shock 3 h after closure of the incision. The total amount of blood produced by the drains was 220 mL.


Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report.

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

Intraoperative findings. Intraoperatively, macroscopic examination of the abdominal cavity shows multiple subserosal bubbles with a diameter of 1-2 mm, mainly around the transverse colon. The appearance of these cystic bubbles is compatible with the characteristics of pneumatosis intestinalis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Intraoperative findings. Intraoperatively, macroscopic examination of the abdominal cavity shows multiple subserosal bubbles with a diameter of 1-2 mm, mainly around the transverse colon. The appearance of these cystic bubbles is compatible with the characteristics of pneumatosis intestinalis.
Mentions: Persistence of abdominal symptoms, absence of upper GI perforation, and results from CT strongly suggested lower intestinal perforation and consequent intestinal necrosis. We therefore decided to perform emergent laparotomy. At the beginning of the operation, vital signs remained stable. Observation of the abdominal cavity found no hydroperitoneum, but intraabdominal tissues appeared friable and hemorrhagic. Although the intestine was explored very carefully from the ligament of Treitz to the pouch of Douglas, no indications of gross perforation, ischemia, or tumor were identified. However, multiple subserosal bubbles (diameter, 1-2 mm) were observed, mainly around the transverse colon (Figure 2). During these procedures, the spleen was slightly injured. Although the injury itself was only slight and easy to repair immediately using pressure with oxidized cellulose (Surgicel), bleeding appeared to continue and total blood loss was estimated at 730 mL. Blood pressure decreased to 65/43 mmHg. Hemoglobin and hematocrit decreased markedly to 4.8 g/dL and 15.3%, respectively. Without any gross detection of intestinal perforation, exploratory laparotomy was completed with placement of two Penrose drains within the abdominal cavity, at which point total blood loss was estimated at 1100 mL. Blood pressure was 58/33 mmHg, heart rate was 67 beats/min, and body temperature was 32.9°C. Despite all resuscitation measures including transfusion, the patient died of hypovolemic shock 3 h after closure of the incision. The total amount of blood produced by the drains was 220 mL.

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