RESUMEN
BACKGROUND: With the prevalence of coronavirus disease 2019 (COVID-19), many severe cases have been discovered worldwide. Here, a case of concurrent pneumomediastinum, pneumoretroperitoneum, and intestinal perforation was reported. This case was the first report on COVID-19-induced related complications. CASE PRESENTATION: A 74-year-old female patient was hospitalized for COVID-19. Air leakage was unexpectedly found during imaging reexamination. Considering the unobvious subjective feeling of the patient, a conservative treatment was given at the early stage, and finally, sigmoid colon perforation was surgically confirmed. The family gave up the treatment at last, because the patient could not be taken off the ventilator. Coincidentally, the patient also had abnormal renal anatomical position. This situation led to an abnormal air leakage direction and the atypical manifestations of peritonitis. It was also one of the important reasons for the delayed diagnosis and treatment of the disease. CONCLUSIONS: Clinicians should be vigilant for spontaneous gastrointestinal perforation in patients with COVID-19, particularly those undergoing treatment with glucocorticoids and tocilizumab. The case is shared to highlight this rare and fatal extrapulmonary manifestation of COVID-19 and further assist clinicians to raise their awareness and timely implement imaging investigation and multidisciplinary intervention so as to facilitate early discovery, diagnosis and treatment and reduce the mortality.
Asunto(s)
COVID-19 , Perforación Intestinal , Enfisema Mediastínico , Retroneumoperitoneo , SARS-CoV-2 , Humanos , COVID-19/complicaciones , Femenino , Anciano , Perforación Intestinal/virología , Perforación Intestinal/etiología , Enfisema Mediastínico/etiología , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/virología , Retroneumoperitoneo/etiología , Retroneumoperitoneo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management. CASE PRESENTATION: A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission. CONCLUSIONS: This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.
Asunto(s)
Diabetes Mellitus Tipo 2 , Diverticulitis , Perforación Intestinal , Enfisema Mediastínico , Peritonitis , Neumoperitoneo , Retroneumoperitoneo , Humanos , Femenino , Anciano , Retroneumoperitoneo/etiología , Retroneumoperitoneo/complicaciones , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiología , Diabetes Mellitus Tipo 2/complicaciones , Peritonitis/diagnóstico , Perforación Intestinal/cirugíaRESUMEN
BACKGROUND: Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) for ureteropelvic junction obstruction (UPJO) has gained growing acceptance among pediatric urologists, and is increasingly performed as day-case surgery, involving smaller children and infants. However, retroperitoneal CO2 insufflation may cause hemodynamic derangements, respiratory changes, and hypercapnia, whose consequences are poorly investigated. We, therefore, decided to prospectively study its effect on regional tissue perfusion and oxygenation in a cohort of pediatric patients undergoing R-RALP, using a dedicated anesthetic protocol and cerebral and renal Near InfraRed Spectroscopy (NIRS). MATERIAL AND METHODS: Between January 2021 and September 2022, a cohort of 21 consecutive children [12 males (9 females), mean age of 7.1 ± 3.8 years and mean body weight of 25.7 ± 12.3 kg] underwent their first elective pyeloplasty for UPJO by R-RALP. The surgical procedure followed a previously described standardized technique and a dedicated anesthetic protocol. In conjunction with the minimal expected standard monitoring, cerebral and renal NIRS were added. Standard monitoring parameters and NIRS values were recorded at preset points throughout the procedures. RESULTS: Standard monitoring and NIRS measurements during R-RALP were not adversely affected by CO2 insufflation, pending a significant increase in respiratory rate, aimed to avoid hypercapnia, while keeping the ventilation pressure within the safety range, preventing lung injury. CONCLUSIONS: R-RALP, using a constant retroperitoneal CO2 insufflation pressure of 12 mmHg with a 5 L.min-1 flow, does not adversely affect respiratory and hemodynamics parameters, pending the implementation of a specifically designed anesthetic protocol aimed to prevent hypercapnia, the most threatening effect of retroperitoneal CO2 insufflation. CLINICAL TRIAL REGISTRATION NUMBER: NCT03274050.
Asunto(s)
Anestésicos , Laparoscopía , Retroneumoperitoneo , Procedimientos Quirúrgicos Robotizados , Obstrucción Ureteral , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Dióxido de Carbono , Hipercapnia , Pelvis Renal/cirugía , Saturación de Oxígeno , Retroneumoperitoneo/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Espectroscopía Infrarroja Corta , Resultado del Tratamiento , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodosAsunto(s)
Cistitis , Enfisema , Neumoperitoneo , Retroneumoperitoneo , Humanos , Retroneumoperitoneo/diagnóstico por imagen , Retroneumoperitoneo/etiología , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiología , Cistitis/diagnóstico , Cistitis/diagnóstico por imagen , Abdomen , Inyecciones Intraperitoneales , Enfisema/complicaciones , Enfisema/diagnóstico por imagenAsunto(s)
Diverticulitis , Enfisema Mediastínico , Neumopericardio , Neumoperitoneo , Retroneumoperitoneo , Femenino , Humanos , Anciano , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Retroneumoperitoneo/diagnóstico por imagen , Retroneumoperitoneo/etiología , Neumopericardio/diagnóstico por imagen , Neumopericardio/etiología , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiologíaRESUMEN
BACKGROUND: Paraquat (1,1-dimethyl-4,4-bipyridinium dichloride) is a toxic herbicide. Accidental ingestion of paraquat in animals and humans causes respiratory failure and death. AIM: To describe the radiographic features of confirmed paraquat intoxication in a group of dogs and determines whether any identified features can facilitate this diagnosis. METHODS: Eleven dogs diagnosed with paraquat intoxication were selected from two institutions between November 2014 and August 2019 comprising five males (all intact) and six females (one intact and five spayed). The mean age was 3.9 ± 2.9 (SD) years and their mean weight was 11.6 ± 5.0 kg. The tentative diagnosis was confirmed through analysis of their urine samples using a colorimetric assay (paraquat concentation 0.39 µg/ml ranging from 0.19-0.65 µg/ml), and their clinical signs were reviewed. Thoracic radiographs were evaluated for the presence of pneumomediastinum, lung patterns (interstitial or alveolar) and their locations (caudodorsal, cranioventral, diffuse, or symmetrical), subcutaneous emphysema, pneumoretroperitoneum, and pneumothorax. RESULTS: The most common clinical signs were dyspnea (11/11, 100%) and anorexia (9/11, 82%). Pneumomediastinum (10/11, 91%) and symmetrically increased lung opacity (7/11, 65%) were the most common radiographic features. Pneumothorax (3/11, 27%), pleural effusion (3/11, 27%), subcutaneous emphysema (2/11, 18%), and pneumoretroperitoneum (1/5, 20%) were the less common findings. None of the dogs survived. CONCLUSION: Pneumomediastinum and diffuse or symmetrical interstitial or alveolar lung patterns are the most common radiographic features in dogs with paraquat intoxication. CLINICAL RELEVANCE: In countries where this herbicide is not banned, paraquat intoxication should be considered if dogs with no history of trauma present with pneumomediastinum.
Asunto(s)
Enfermedades de los Perros/diagnóstico por imagen , Paraquat/envenenamiento , Tórax/diagnóstico por imagen , Animales , Perros , Femenino , Enfermedades Pulmonares Intersticiales/veterinaria , Masculino , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/veterinaria , Paraquat/orina , Neumotórax/diagnóstico por imagen , Neumotórax/veterinaria , Radiografía/veterinaria , Retroneumoperitoneo/diagnóstico por imagen , Retroneumoperitoneo/veterinaria , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/veterinariaAsunto(s)
Riñón/diagnóstico por imagen , Alveolos Pulmonares/lesiones , Respiración Artificial/efectos adversos , Retroneumoperitoneo/diagnóstico por imagen , Retroneumoperitoneo/etiología , Lesión Pulmonar Inducida por Ventilación Mecánica/diagnóstico por imagen , Adulto , Femenino , Humanos , Alveolos Pulmonares/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/terapia , Lesión Pulmonar Inducida por Ventilación Mecánica/etiologíaAsunto(s)
Absceso/diagnóstico por imagen , Absceso/cirugía , Diverticulosis del Colon/diagnóstico por imagen , Diverticulosis del Colon/cirugía , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Retroneumoperitoneo/diagnóstico por imagen , Retroneumoperitoneo/cirugía , Escroto/diagnóstico por imagen , Escroto/cirugía , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Humanos , Laparotomía , Masculino , Persona de Mediana EdadAsunto(s)
Absceso/microbiología , Diabetes Mellitus/microbiología , Escherichia coli/fisiología , Enfisema Mediastínico/microbiología , Peritoneo/microbiología , Peritoneo/patología , Neumoperitoneo/microbiología , Retroneumoperitoneo/microbiología , Absceso/diagnóstico por imagen , Femenino , Humanos , Enfisema Mediastínico/diagnóstico por imagen , Persona de Mediana Edad , Peritoneo/diagnóstico por imagen , Neumoperitoneo/complicaciones , Neumoperitoneo/diagnóstico por imagen , Retroneumoperitoneo/complicaciones , Retroneumoperitoneo/diagnóstico por imagenRESUMEN
We report a case of incarcerated left indirect inguinal hernia in a male child which on exploration revealed the presence of free air and fecal matter containing fluid in the hernial sac. This is the second reported case of the presence of cecal perforation in left Amyand's hernia in pediatric age group and unique in the sense of the form of abnormal anatomy encountered per-operatively.
Asunto(s)
Hernia Inguinal/complicaciones , Perforación Intestinal/etiología , Retroneumoperitoneo/etiología , Ciego , Preescolar , Humanos , MasculinoRESUMEN
BACKGROUND: Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures. METHODS: A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was carried out using the PubMed database, identifying 40 articles with the following keywords: "transanal" AND "emphysema"; "transanal" AND "subcutaneous emphysema"; "transanal" AND "pneumomediastinum"; "transanal" AND "pneumothoraces"; "transanal" AND "pneumopericardium"; "transanal" AND "retropneumoperitoneum". RESULTS: Nineteen articles, published between 1993 and 2017, were included in the study for a total of 29 patients. The most frequent air localization was in the retroperitoneum, followed by subcutaneous tissues, mediastinum and neck. This condition was treated conservatively in 20 patients, with colostomy in 4 patients, with bowel resection and negative diagnostic laparoscopy in one patient each. In three cases the treatment was not specified. Ectopic air location resolved in all cases. CONCLUSIONS: Pneumo-mediastinum and pneumo-retroperitoneum after transanal procedures are unusual complications with a dramatic radiological appearance but can be managed successfully with a completely benign course in most cases. Initially, a conservative approach is recommended. Surgical treatment should be reserved only in case of fluid collection or suture dehiscence.
Asunto(s)
Enfisema Mediastínico/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Retroneumoperitoneo/diagnóstico por imagen , Enfisema Subcutáneo/diagnóstico por imagen , Cirugía Endoscópica Transanal/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Enfisema Mediastínico/epidemiología , Enfisema Mediastínico/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Radiografía , Retroneumoperitoneo/epidemiología , Retroneumoperitoneo/etiología , Enfisema Subcutáneo/epidemiología , Enfisema Subcutáneo/etiologíaAsunto(s)
Resección Endoscópica de la Mucosa/efectos adversos , Enfisema Mediastínico/etiología , Neumopericardio/etiología , Neumoperitoneo/etiología , Retroneumoperitoneo/etiología , Enfisema Subcutáneo/etiología , Anciano , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/terapia , Neumopericardio/diagnóstico , Neumopericardio/terapia , Neumoperitoneo/diagnóstico , Neumoperitoneo/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Retroneumoperitoneo/diagnóstico , Retroneumoperitoneo/terapia , Enfisema Subcutáneo/diagnóstico , Enfisema Subcutáneo/terapiaRESUMEN
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