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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

Macroscopic appearance of the ascending colon. These pictures show two sides of a specimen of the ascending colon dissected at autopsy (A: mucosal side; B: serous side). The macroscopic appearance of the specimen shows diffuse hemorrhage on both serous and mucosal sides, but a lack of any necrotic feature, consistent with a finding of intraluminal bleeding.
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Figure 3: Macroscopic appearance of the ascending colon. These pictures show two sides of a specimen of the ascending colon dissected at autopsy (A: mucosal side; B: serous side). The macroscopic appearance of the specimen shows diffuse hemorrhage on both serous and mucosal sides, but a lack of any necrotic feature, consistent with a finding of intraluminal bleeding.

Mentions: Autopsy was performed at 20 h 25 min after death. A total of 150 mL of hemorrhagic ascites was observed within the abdomen. Diffuse bleeding was apparent around the left diaphragm, and multiple nodular hemorrhages were detected on the greater omentum. The spleen weighed 50 g, with no specific gross abnormalities other than a small amount of bleeding, and the liver weighed 820 g. The PEG tube was without abnormality. No specific findings were noted from the duodenum to the terminal ileum. Multiple emphysematous foci were detected on the serosa and mucosa from the terminal ileum to the descending colon (Figure 3), and a 3-cm hematoma was present on the serosa of the ascending colon. Blood was grossly detected intratubally from the terminal ileum to the descending colon. Diffuse hemorrhagic changes were present horizontally on the mucosal side and to a lesser degree on the serous side, consistent with a finding of intraluminal bleeding. Numerous cystic bubbles, each 1-2 mm in diameter, were present within several layers in vertical specimens of the mucosal layer. No signs of obvious necrotic change or coagulant necrosis were seen within the intestine. On the basis of the autopsy findings, cause of death was determined as hypovolemic shock due to intraluminal hemorrhage from the terminal ileum to the descending colon, with fulminant onset in the perioperative period.


Pneumatosis intestinalis leading to perioperative hypovolemic shock: Case report.

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

Macroscopic appearance of the ascending colon. These pictures show two sides of a specimen of the ascending colon dissected at autopsy (A: mucosal side; B: serous side). The macroscopic appearance of the specimen shows diffuse hemorrhage on both serous and mucosal sides, but a lack of any necrotic feature, consistent with a finding of intraluminal bleeding.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Macroscopic appearance of the ascending colon. These pictures show two sides of a specimen of the ascending colon dissected at autopsy (A: mucosal side; B: serous side). The macroscopic appearance of the specimen shows diffuse hemorrhage on both serous and mucosal sides, but a lack of any necrotic feature, consistent with a finding of intraluminal bleeding.
Mentions: Autopsy was performed at 20 h 25 min after death. A total of 150 mL of hemorrhagic ascites was observed within the abdomen. Diffuse bleeding was apparent around the left diaphragm, and multiple nodular hemorrhages were detected on the greater omentum. The spleen weighed 50 g, with no specific gross abnormalities other than a small amount of bleeding, and the liver weighed 820 g. The PEG tube was without abnormality. No specific findings were noted from the duodenum to the terminal ileum. Multiple emphysematous foci were detected on the serosa and mucosa from the terminal ileum to the descending colon (Figure 3), and a 3-cm hematoma was present on the serosa of the ascending colon. Blood was grossly detected intratubally from the terminal ileum to the descending colon. Diffuse hemorrhagic changes were present horizontally on the mucosal side and to a lesser degree on the serous side, consistent with a finding of intraluminal bleeding. Numerous cystic bubbles, each 1-2 mm in diameter, were present within several layers in vertical specimens of the mucosal layer. No signs of obvious necrotic change or coagulant necrosis were seen within the intestine. On the basis of the autopsy findings, cause of death was determined as hypovolemic shock due to intraluminal hemorrhage from the terminal ileum to the descending colon, with fulminant onset in the perioperative period.

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