RESUMO
La neumatosis intestinal es una entidad muy infrecuente asociada a varias patologías, como el infarto intestino-mesentérico, la enterocolitis necrotizante y la enfermedad pulmonar obstructiva crónica. Se caracteriza por la presencia de gas en la subserosa o submucosa a través del tracto gastrointestinal. Presentamos el caso de un paciente de sexo masculino de 63 años de edad que consultó por dolor en abdomen superior, vómitos y fiebre elevada (39º) nueve días después de una gastrectomía total por cáncer. La radiografía directa de abdomen constató distensión intestinal y la tomografía computada (TC) demostró distensión intestinal, edema mesentérico, neumatosis intestinal a través del intestino delgado y neumatosis portal, preferentemente en el lóbulo hepático izquierdo. Se realizó una laparotomía de urgencia que reveló únicamente distensión intestinal por adherencias, sin evidenciar necrosis intestinal. El paciente evolucionó desfavorablemente, falleciendo posteriormente. Reportamos un nuevo caso y revisamos la literatura de la neumatosis intestinal asociada con neumatosis portal.
The pneumatosis intestinalis is a very infrequent condition associated with a number of diseases, such as mesenteric infarction, necrotizing enterocolitis, and obstructive pulmonary disease characterized by the presence of subserosal or submucosal gas cyst throughout the gastrointestinal tract. A 63- year- old man complained of upper abdominal pain, vomiting and high fever (39º C) on the nine day after total gastrectomy for cancer. Abdominal X-ray revealed intestinal distension. The abdominal Computed Tomography (CT) showed intestinal dilatation, mesenteric oedema, diffuse pneumatosis throughout the small intestine and gas in the portal venous system predominantly in the left hepatic lobe. It was performed emergency activity that revealed intestinal distension secondary to adhesion without intestinal necrosis. The patient had a downhill course and died thereafter. We report a new case and reviewed the literature of pneumatosis intestinalis associated with hepatic portal venous gas.
RESUMO
BACKGROUND: Inflammatory pseudotumor of the liver is an infrequent, fibroinflammatory non-neoplastic process of unknown etiology, generally following a benign inflammatory condition. The importance of knowledge of it resides in its similar presentation to other hepatic tumors in clinical picture, radiological appearance, and macroscopic pattern. CASE REPORT: A 71-year-old woman presented with acute abdominal pain. Ultrasonography and a computerized tomography (CT) scan showed a 3.2 cm hepatic tumor (segment IV) and a CT-guided liver biopsy revealed possible histological features of hepatic fibrosarcoma. The patient underwent a wedge resection. The pathologist identified a well-defined, 4-cm inflammatory pseudotumor of the liver associated with possible sclerosing cholangitis lesion. CONCLUSIONS: Inflammatory pseudotumor is a fibroinflammatory non-neoplastic process that should be suspected in patients with a hepatic tumor with significant infectious-inflammatory history. Percutaneous hepatic biopsy does not provide certainty in confirming the lesion since it does not discard focuses of hidden malignancy. The treatment is surgical resection followed by histopatological study to eliminate a hepatocarcinoma, a low-grade fibrosarcoma, or a hidden focus of adenocarcinoma. The inflammatory pseudotumor of the liver has changed from being an extremely rare pathology to becoming an established liver disease.
