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1.
Medicine (Baltimore) ; 99(40): e22461, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019436

RESUMO

Pneumoperitoneum has always been considered a surgical emergency as it represents a perforation of the gastrointestinal tract. Although several cases of pneumoperitoneum with pneumatosis intestinalis (PI) have been reported, the characteristics of such cases remain unclear. The current study aimed to clarify the clinical characteristics of pneumoperitoneum cases with PI detected using computed tomography (CT).This descriptive study was conducted at a single center. In a total of 18,513 abdominal CT scans obtained between January 2010 and February 2017, extraluminal free air was detected in 254 examinations of 182 cases. The medical records and CT images of these 182 patients were retrospectively analyzed.Pneumoperitoneum with PI was detected through 23 examinations in 21 cases, and the average age of the patients was 80.1 years. The frequency was 0.12% in all abdominal CT examinations, but 24.7% in the 85 cases with extraluminal free air, excluding iatrogenic air. PI was classified as benign in 20 cases and as life-threatening in 1 case. The majority of cases with benign PI showed good general and local findings and little leukocytosis, while the case with life-threatening PI showed severe conditions. No evidence of bowel wall discontinuity, segmental bowel-wall thickening, perivisceral fat stranding, and abscesses were observed. Ascites were detected less frequently in the cases with PI than in the other pneumoperitoneum cases (P < .01). Pneumoperitoneum and PI occasionally recurred, and PI and/or extraluminal free air generally disappeared quickly.Pneumoperitoneum with PI is a relatively common condition in older patients, and the majority of cases are caused by benign PI. The characteristics of pneumoperitoneum cases with benign PI include well-maintained physical conditions, normal laboratory data, absence of CT findings indicative of peritonitis, and infrequent ascites. In pneumoperitoneum cases with PI, predicting whether the PI is benign or life-threatening is clinically very important, whereas the presence of extraluminal free air is considered to be insignificant.


Assuntos
Pneumatose Cistoide Intestinal/patologia , Pneumoperitônio/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumoperitônio/complicações , Pneumoperitônio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
6.
Vet Radiol Ultrasound ; 61(3): E26-E30, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-29797615

RESUMO

An adult cat was presented for acute history of vomiting and collapse. Radiographs showed the presence of air within small intestinal walls and arborizing gas patterns within the liver, compatible with pneumatosis intestinalis and presumed portal venous gas, respectively. An abdominal ultrasound the following day was suggestive of gas within the intestinal wall, however, gas within the hepatic vasculature, parenchyma, or biliary tree was not evident. Due to progressive clinical deterioration of the patient, the owners elected humane euthanasia. Necropsy revealed severe necrotizing hemorrhagic enterotyphlocolitis secondary to Clostridium difficile toxin.


Assuntos
Doenças do Gato/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Pneumatose Cistoide Intestinal/veterinária , Animais , Doenças do Gato/microbiologia , Doenças do Gato/patologia , Gatos , Enterocolite/diagnóstico por imagem , Enterocolite/patologia , Enterocolite/veterinária , Feminino , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/patologia , Veia Porta/diagnóstico por imagem , Radiografia/veterinária , Ultrassonografia/veterinária
7.
BMC Gastroenterol ; 19(1): 176, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694581

RESUMO

BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is a low-incidence disease that confuses many doctors. A vast number of factors are suspected to contribute to its pathogenesis, such as Crohn's disease, intestinal stenosis, ulcerative colitis, drug use, extra-gastrointestinal diseases, and chronic obstructive pulmonary disease. Most consider its pathogenesis interrelated to an increase in intra-intestinal pressure and the accumulation of gas produced by aerogenic bacteria, and patients with atypical symptoms and imaging manifestations tend to be misdiagnosed. CASE PRESENTATION: A 64-year-old man complained of a 3-month history of bloody stool without mucopurulent discharge, abdominal pain, or diarrhea. Colonoscopy revealed multiple nodular projections into the segmental mucosa of the sigmoid colon. Crohn's disease and malignant disease ware suspected first according to the patient's history, but laboratory examinations did not confirm either. Endoscopic ultrasound (EUS) revealed multiple cystic lesions in the submucosa. Moreover, computer tomography scan showed multiple bubble-like cysts. Combined with ultrasonography, computed tomography, and pathology findings, we ultimately made a diagnosis of PCI. Instead of surgery, we recommended conservative treatment consisting of endoscopy and oral drug administration. His symptoms improved with drug therapy after discharge, and no recurrence was noted on follow-up. CONCLUSIONS: The incidence of PCI is low. Due to a lack of specificity in clinical manifestations and endoscopic findings, it often misdiagnosed as intestinal polyps, tumors, inflammatory bowel disease, or other conditions. Colonoscopy, computed tomography, and ultrasonography have demonstrated benefit in patients with multiple nodular projections in colon. Compared to the treatment of the above diseases, PCI treatment is effective and convenient, and the prognosis is optimistic. Therefore, clinicians should increase their awareness of PCI to avoid unnecessary misdiagnosis.


Assuntos
Pneumatose Cistoide Intestinal/diagnóstico , Biópsia , Colonoscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/tratamento farmacológico , Pneumatose Cistoide Intestinal/patologia , Tomografia Computadorizada por Raios X , Ultrassonografia
8.
Toxicol Ind Health ; 35(7): 482-485, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31364505

RESUMO

Acute organophosphorus pesticide poisoning (AOPP) is fairly common in rural areas of Asia. The symptoms of AOPP are mainly caused by acetylcholine accumulation. According to the clinical characteristics, AOPP symptoms can fall into the following three categories: muscarinic, nicotinic, and central. Death from fatal poisoning is caused by respiratory paralysis, and neurological complications are common. However, no case of intestinal necrosis caused by AOPP has been reported. Hepatic portal vein gas and pneumatosis intestinalis are considered typical and early imaging manifestations of intestinal necrosis. In this article, we describe a very rare case of computed tomography imaging-proven intestinal necrosis caused by AOPP.


Assuntos
Diclorvós/toxicidade , Intestinos/patologia , Necrose/induzido quimicamente , Intoxicação por Organofosfatos/patologia , Pneumatose Cistoide Intestinal/induzido quimicamente , Veia Porta/patologia , Adulto , Feminino , Humanos , Necrose/patologia , Pneumatose Cistoide Intestinal/patologia , Tentativa de Suicídio , Tomografia Computadorizada por Raios X
9.
BMJ Case Rep ; 12(7)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366614

RESUMO

A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Colectomia , Ileostomia , Laparotomia , Pneumatose Cistoide Intestinal/patologia , Rituximab/uso terapêutico , Idoso , Artrite Reumatoide/fisiopatologia , Feminino , Humanos , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Scand J Gastroenterol ; 54(8): 953-959, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31361977

RESUMO

Background: Acute mesenteric ischemia (AMI) is a rare life-threatening condition, especially for the patients with transmural intestinal necrosis (TIN). However, the optimal time for surgical intervention is controversial. As a series study, this study aimed to identify the outcomes and clinical characteristic of patients with TIN. Methods: Clinical data of 158 patients with AMI from January 2010 to December 2017 were retrospectively analyzed in a national gastrointestinal referral center in China to confirm the outcomes and identify predictors for TIN. Results: According to the results of pathological assessment and follow-up, 62 patients were TIN and 96 were non-TIN. Patients with TIN have a higher mortality and incidence of severe complications. The significant independent predictors for TIN were arterial lactate level (OR: 4.76 [2.29 ∼ 9.89]), free intraperitoneal fluid (OR: 9.49 [2.56 ∼ 35.24]) and pneumatosis intestinalis (OR: 7.08 [1.68 ∼ 29.82]) in computed tomography (CT) scan imaging. The overall area under the receiver operating characteristics (ROC) curve of the model was 0.934 (95% confidence interval: 0.893 ∼ 0.974). Using ROC curve, the cutoff value of arterial lactate level predicting the onset of TIN was 2.65 mmol/L. Conclusions: Patients concomitant with TIN manifest a higher risk of poor prognosis. The three predictors for TIN were arterial lactate level >2.65 mmol/L, free intraperitoneal fluid and pneumatosis intestinalis. Close monitoring these predictors would help identify AMI patients developed TIN and in urgent need for bowel resection.


Assuntos
Intestino Delgado/patologia , Isquemia Mesentérica/complicações , Pneumatose Cistoide Intestinal/patologia , Doença Aguda , Adulto , Idoso , China , Feminino , Humanos , Intestino Delgado/diagnóstico por imagem , Masculino , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/cirurgia , Pessoa de Meia-Idade , Necrose/etiologia , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/cirurgia , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Am J Emerg Med ; 37(10): 1993.e1-1993.e3, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31262624

RESUMO

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 4 years ago, with a heroin abuse history. He presented with abdominal distension ongoing for 4 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 5 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.


Assuntos
Anti-Inflamatórios/uso terapêutico , Hidrocortisona/uso terapêutico , Metilprednisolona/uso terapêutico , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumoperitônio/diagnóstico por imagem , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem , Dependência de Heroína/complicações , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/tratamento farmacológico , Pneumatose Cistoide Intestinal/patologia , Pneumoperitônio/tratamento farmacológico , Pneumoperitônio/patologia , Radiografia Abdominal , Síndrome da Artéria Mesentérica Superior/tratamento farmacológico , Síndrome da Artéria Mesentérica Superior/patologia , Resultado do Tratamento , Vômito
15.
Med Ultrason ; 21(1): 30-36, 2019 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-30779828

RESUMO

AIMS: To evaluate ultrasound findings in order to determine potential predictors of prognosis in pediatric patients with portal venous gas (PVG) detected by ultrasound. MATERIALS AND METHODS: Thirty-nine children were included and divided into two groups: benign PVG (n=24) and life-threatening PVG (n=15; 6 surgical interventions and 9 deaths). Possible predictors, i.e., the location of PVG in the liver, the distribution of intestinal pneumatosis, ascites and free air were compared between the two groups. RESULTS: A significant difference was noted between the two groups in terms of the distribution of intestinal pneumatosis (limited to the large bowel, benign vs life-threatening = 60.9% (14/23):21.4% (3/14), p=0.040), the absence of ascites (benign vs life-threatening = 79.1% (19/24):40.0% (6/15), p=0.019) and patient age (benign vs life-threatening = 52.5±65.3 months vs 19.7±44.0 months, p=0.019). No significant difference was observed in the location of PVG in the liver, the presence of free air, and sex between the two groups. CONCLUSIONS: In pediatric patients with PVG, including various ages and underlying diseases, intestinal pneumatosis limited to the large bowel and absence of ascites were predictors of a benign prognosis. However, despite the presence of these predictors, some patients with PVG required surgical intervention, therebysuggesting that the cause of PVG, such as necrotizing enterocolitis, volvulus, or pancreatitis, must be also carefully evaluated.


Assuntos
Enteropatias/complicações , Enteropatias/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Ultrassonografia , Adolescente , Ascite/complicações , Ascite/diagnóstico por imagem , Ascite/patologia , Criança , Pré-Escolar , Feminino , Gases , Humanos , Lactente , Recém-Nascido , Enteropatias/patologia , Intestinos/diagnóstico por imagem , Intestinos/patologia , Intestinos/cirurgia , Masculino , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/patologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
16.
BMC Surg ; 19(1): 17, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717721

RESUMO

BACKGROUND: Hepatic portal vein gas (HPVG) is a rare acute abdomen, which is not an independent disease. Meanwhile, HPVG combined with appendicitis has been rarely reported. We found only a similar report by looking for literature, but no intestinal necrosis occurred. We report a patient with HPVG, appendicitis and intestinal necrosis was reported in the current study. The patient was given frequent monitoring and had been conducted operation in time. CASE PRESENTATION: An 86-year-old female with appendicitis complicated by HPVG was reported in the present study. Abdominal examination revealed rebound tenderness at the McBurney's point. Moreover, abdominal computed tomography (CT) revealed gas in portal and mesenteric veins in addition to appendicitis. An emergency operation was planned on the appendix. However, the patient refused surgical treatment. Therefore, conservative treatment of antibiotics and frequent imaging observation was conducted for this patient. Although imaging results suggested disappeared gas in intra- and extra-hepatic portal veins, the small intestine was dilated, after conservative treatment of antibiotics. In addition, signs of diffused peritonitis could also be observed and an exploratory laparotomy was performed. Intra-operative findings had confirmed suppurated appendix, mesenteric ischemia and small intestinal necrosis. CONCLUSIONS: Frequent monitoring benefits us in observing the progress of intestinal diseases. When there exist other possible causes of HPVG such as infection, it is not easy for us to ignore the possibility of intestinal necrosis.


Assuntos
Apendicite/cirurgia , Enfisema/diagnóstico por imagem , Intestino Delgado/patologia , Isquemia Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Idoso de 80 Anos ou mais , Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Tratamento Conservador , Enfisema/cirurgia , Feminino , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparotomia , Isquemia Mesentérica/cirurgia , Monitorização Fisiológica , Necrose , Peritonite/diagnóstico , Peritonite/cirurgia , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/patologia , Pneumatose Cistoide Intestinal/cirurgia , Tomografia Computadorizada por Raios X , Falha de Tratamento , Recusa do Paciente ao Tratamento
19.
BMC Cancer ; 18(1): 825, 2018 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-30115025

RESUMO

BACKGROUND: Pneumatosis intestinalis (PI) is a rare complication of chemotherapy, characterized by multiple gas accumulations within the bowel wall. CASE PRESENTATION: A 71-year-old woman with epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma was admitted to our hospital because of reduced consciousness. She was diagnosed as having leptomeningeal carcinomatosis (LM) using lumbar puncture. Because she could not swallow a tablet, erlotinib was administered via a feeding tube. Her state of consciousness gradually improved, but she experienced diarrhea several times a day. After 3 weeks of erlotinib therapy, PI occurred. Erlotinib was discontinued and PI was resolved after treatment with conservative therapies. Erlotinib was re-administrated and PI occurred again. After improvement of erlotinib-induced PI, gefitinib was administered by a feeding tube and the patient did not experience PI or diarrhea. The patient survived 8 months from the diagnosis of LM. CONCLUSION: PI is one of the side effects of erlotinib, and consecutive therapies are useful for the treatment of PI. In this patient, gefitinib was successfully administered after erlotinib-induced PI.


Assuntos
Neoplasias Pulmonares/tratamento farmacológico , Carcinomatose Meníngea/tratamento farmacológico , Pneumatose Cistoide Intestinal/tratamento farmacológico , Quinazolinas/administração & dosagem , Idoso , Receptores ErbB/antagonistas & inibidores , Cloridrato de Erlotinib/administração & dosagem , Cloridrato de Erlotinib/efeitos adversos , Feminino , Gefitinibe , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Carcinomatose Meníngea/complicações , Carcinomatose Meníngea/patologia , Pneumatose Cistoide Intestinal/induzido quimicamente , Pneumatose Cistoide Intestinal/patologia , Inibidores de Proteínas Quinases/administração & dosagem , Inibidores de Proteínas Quinases/efeitos adversos
20.
BMJ Case Rep ; 20182018 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-30030242

RESUMO

Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that underwent diagnostic surgery and finally diagnosed by midgut malrotation and antral stenosis. A 40-year-old man with 1-year history of dyspepsia and vomiting which was aggravated by 20 kg underweight since 3 months ago, despite medications was presented. His imaging examinations showed partial antral obstruction besides pneumoperitoneum and gas collection in the small intestine wall, which were in favour of PI. Samplings of the small intestine during laparotomy reported simple serosal cysts. Persistence of his symptoms forced him to recourse to another hospital and their new imaging revealed Ladds' band in addition to mentioned findings in previous studies; he underwent subtotal gastrectomy plus Ladds' band division by Braun gastrojejunostomy. PI could be a presentation of antral stenosis and midgut malrotation. PI with pneumoperitoneum needs surgical interventions. Considering that most of the midgut malrotation cases are diagnosed in the first year of life and it is very rare in adults, it may bethat these new findings are due to adhesion band formation after the first surgery in this case.


Assuntos
Anormalidades do Sistema Digestório/complicações , Volvo Intestinal/complicações , Pneumatose Cistoide Intestinal/etiologia , Pneumoperitônio/etiologia , Antro Pilórico/patologia , Adulto , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Anormalidades do Sistema Digestório/diagnóstico por imagem , Humanos , Volvo Intestinal/diagnóstico por imagem , Masculino , Pneumatose Cistoide Intestinal/patologia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/patologia , Antro Pilórico/diagnóstico por imagem
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