RESUMO
A 65-year-old woman was admitted with sudden-onset abdominal pain. Abdominal computed tomography revealed hepatic portal venous gas. Physical and laboratory examination suggested that a conservative approach was appropriate; however, 4 days later, the pain recurred and severe ischemic enteritis was diagnosed. A stenosis was identified 60 cm distal to the start of the ileum, and partial resection of the small intestine was performed. The diagnosis of ischemic enteritis was confirmed. Ischemic enteritis affecting the small intestine is uncommon, and enteritis causing intestinal stenosis with hepatic portal vein gas is even rarer.
Assuntos
Embolia Aérea/etiologia , Ileíte/complicações , Íleo/irrigação sanguínea , Isquemia/complicações , Veia Porta , Idoso , Constrição Patológica , Procedimentos Cirúrgicos do Sistema Digestório , Embolia Aérea/diagnóstico , Feminino , Humanos , Ileíte/patologia , Ileíte/cirurgia , Íleo/patologia , Íleo/cirurgia , Isquemia/patologia , Isquemia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Biliary drainage was performed in a 71-year-old man with obstructive jaundice of unknown origin; however, he died due to acute pulmonary failure. At autopsy, proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC) to the subserosa and bile ducts without growth toward the gallbladder lumen. Furthermore, fibrocellular intimal proliferation, tumor emboli and organized thrombi were observed in the small pulmonary arteries. The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM). PTTM may present as rapidly progressive dyspnea, and a high level of clinical suspicion is required to make the differential diagnosis.