RESUMEN
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. PI can be both asymptomatic and life-threatening. The patient was a 50-year-old man with previous cervical spine abscess and osteomyelitis post debridement 4â¯years ago, with a heroin abuse history. He presented with abdominal distension ongoing for 4â¯days and vomiting for 3 times with fluid content. Abdominal computed tomography revealed pneumatosis with pneumoretroperitoneum. A surgeon was contacted and antibiotic treatment was started. The patient was kept on nothing per os and intravenous fluid supply. A drainage tube was inserted into retroperitoneum space on the same day. Tracing back his history, our patient was discharged from the hospital recently with a diagnosis of superior mesenteric artery dyndrome (SMAS), hypersensitivity pneumonitis, and asbestosis with soft tissue pleural plaques and calcified pleural plaques. During the hospitalization period, hydrocortisone dexamethasone and methylprednisolone were prescribed for hypersensitivity pneumonitis. Steroid use and SMAS maybe the cause of PI. Finally, he was discharged 5â¯days later with a nasojejunal and drainage tubes and was arranged for OPD follow-up. PI can be asymptomatic or life-threatening, and patient management varies based on the clinical condition. Although in this case PI was found in the emergency department, a patient's past history of underlying disease and medication should be reviewed to find the most possible etiology.
Asunto(s)
Antiinflamatorios/uso terapéutico , Hidrocortisona/uso terapéutico , Metilprednisolona/uso terapéutico , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Neumoperitoneo/diagnóstico por imagen , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagen , Dependencia de Heroína/complicaciones , Humanos , Masculino , Anamnesis , Persona de Mediana Edad , Neumatosis Cistoide Intestinal/tratamiento farmacológico , Neumatosis Cistoide Intestinal/patología , Neumoperitoneo/tratamiento farmacológico , Neumoperitoneo/patología , Radiografía Abdominal , Síndrome de la Arteria Mesentérica Superior/tratamiento farmacológico , Síndrome de la Arteria Mesentérica Superior/patología , Resultado del Tratamiento , VómitosRESUMEN
The aim of this study was to investigate the outcome, and optimal duration of medical treatment in children with superior mesenteric artery syndrome (SMAS). Eighteen children with SMAS were retrospectively studied. The data reviewed included demographics, presenting symptoms, co-morbid conditions, clinical courses, nutritional status, treatments, and outcomes. The three most common symptoms were postprandial discomfort (67.7%), abdominal pain (61.1%), and early satiety (50%). The median duration of symptoms before diagnosis was 68 days. The most common co-morbid condition was weight loss (50%), followed by growth spurt (22.2%) and bile reflux gastropathy (16.7%). Body mass index (BMI) was normal in 72.2% of the patients. Medical management was successful in 13 patients (72.2%). The median duration of treatment was 45 days. Nine patients (50%) had good outcomes without recurrence, 5 patients (27.8%) had moderate outcomes, and 4 patients (22.2%) had poor outcomes. A time limit of >6 weeks for the duration of medical management tended to be associated with worse outcomes (P=0.018). SMAS often developed in patients with normal BMI or no weight loss. Medical treatment has a high success rate, and children with SMAS should be treated medically for at least 6 weeks before surgical treatment is considered.
Asunto(s)
Síndrome de la Arteria Mesentérica Superior/diagnóstico , Adolescente , Reflujo Biliar/diagnóstico , Niño , Preescolar , Demografía , Domperidona/uso terapéutico , Antagonistas de Dopamina/uso terapéutico , Esquema de Medicación , Femenino , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Lactante , Masculino , Nutrición Parenteral , Estudios Retrospectivos , Síndrome de la Arteria Mesentérica Superior/tratamiento farmacológico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Pérdida de PesoAsunto(s)
Enfermedades del Prematuro/terapia , Recien Nacido Prematuro , Síndrome de la Arteria Mesentérica Superior/complicaciones , Síndrome de la Arteria Mesentérica Superior/diagnóstico , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Dexametasona/efectos adversos , Dexametasona/uso terapéutico , Nutrición Enteral/métodos , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/terapia , Humanos , Recién Nacido , Recien Nacido Prematuro/crecimiento & desarrollo , Cuidado Intensivo Neonatal , Lansoprazol , Masculino , Síndrome de la Arteria Mesentérica Superior/tratamiento farmacológico , Vómitos/etiologíaRESUMEN
Henoch-Schonlein purpura (HSP) is an inflammatory vasculitis involving the skin, joints, gastrointestinal (GI) tract, and kidneys. This is the first case report describing a 5-year-old girl with HSP presenting duodenal involvement which might be associated with superior mesenteric artery syndrome (SMAS).