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2.
Anesthesiology ; 132(4): 667-677, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32011334

RESUMO

BACKGROUND: Pneumoperitoneum for laparoscopic surgery is associated with a rise of driving pressure. The authors aimed to assess the effects of positive end-expiratory pressure (PEEP) on driving pressure at varying intraabdominal pressure levels. It was hypothesized that PEEP attenuates pneumoperitoneum-related rises in driving pressure. METHODS: Open-label, nonrandomized, crossover, clinical trial in patients undergoing laparoscopic cholecystectomy. "Targeted PEEP" (2 cm H2O above intraabdominal pressure) was compared with "standard PEEP" (5 cm H2O), with respect to the transpulmonary and respiratory system driving pressure at three predefined intraabdominal pressure levels, and each patient was ventilated with two levels of PEEP at the three intraabdominal pressure levels in the same sequence. The primary outcome was the difference in transpulmonary driving pressure between targeted PEEP and standard PEEP at the three levels of intraabdominal pressure. RESULTS: Thirty patients were included and analyzed. Targeted PEEP was 10, 14, and 17 cm H2O at intraabdominal pressure of 8, 12, and 15 mmHg, respectively. Compared to standard PEEP, targeted PEEP resulted in lower median transpulmonary driving pressure at intraabdominal pressure of 8 mmHg (7 [5 to 8] vs. 9 [7 to 11] cm H2O; P = 0.010; difference 2 [95% CI 0.5 to 4 cm H2O]); 12 mmHg (7 [4 to 9] vs.10 [7 to 12] cm H2O; P = 0.002; difference 3 [1 to 5] cm H2O); and 15 mmHg (7 [6 to 9] vs.12 [8 to 15] cm H2O; P < 0.001; difference 4 [2 to 6] cm H2O). The effects of targeted PEEP compared to standard PEEP on respiratory system driving pressure were comparable to the effects on transpulmonary driving pressure, though respiratory system driving pressure was higher than transpulmonary driving pressure at all intraabdominal pressure levels. CONCLUSIONS: Transpulmonary driving pressure rises with an increase in intraabdominal pressure, an effect that can be counterbalanced by targeted PEEP. Future studies have to elucidate which combination of PEEP and intraabdominal pressure is best in term of clinical outcomes.


Assuntos
Abdome/fisiopatologia , Laparoscopia/métodos , Monitorização Intraoperatória/métodos , Pneumoperitônio/fisiopatologia , Respiração com Pressão Positiva/métodos , Idoso , Estudos Cross-Over , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio/diagnóstico , Pneumoperitônio/etiologia , Respiração com Pressão Positiva/efeitos adversos , Volume de Ventilação Pulmonar/fisiologia
5.
Am J Case Rep ; 20: 1039-1045, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31316049

RESUMO

BACKGROUND Rupture of a pyogenic liver abscess is rare but serious complication. In patients after pancreatoduodenectomy, there are some conditions causing the development of liver abscesses (e.g., chronic reflux-cholangitis, efferent jejunal loop stasis, stenosis of the biliary anastomosis, and pancreatogenic diabetes). However, the number of published cases of liver abscess after pancreatoduodenectomy is small. CASE REPORT A 42-year-old male was admitted with severe abdominal pain, fever, and jaundice. Nineteen years previously, he had undergone pancreatoduodenectomy and cholecystectomy for chronic pancreatitis with obstructive jaundice. Two years later, diabetes mellitus was diagnosed, with subsequent insulin treatment. At admission, symptoms of peritonitis were present. Plain abdominal radiography showed free gas under the right hemidiaphragm and heterogeneous liver shade with small gas-fluid levels. The rupture of a liver abscess was suspected. Laparotomy with adhesiolysis, debridement of the liver abscess cavity, and abdominal drainage were performed. The postoperative period was complicated by sepsis, right lower lobe pneumonia, and two-sided pleural effusions, on the background of insulin-dependent diabetes and malnutrition. The patient was discharged on the 40th day and the subdiaphragmatic drains were removed on the 114th day. Sixteen months after surgery, the patient's condition was satisfactory. Magnetic resonance imaging and echography showed the absence of biliary hypertension. The liver tissue had healed completely. CONCLUSIONS A unique case of ruptured liver abscess after pancreatoduodenectomy is presented. To the best of our knowledge, this is the first published case with such a long time interval (19 years) between pancreatoduodenectomy and the formation of a pyogenic liver abscess.


Assuntos
Abscesso Hepático Piogênico/etiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreatite Crônica/cirurgia , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Humanos , Abscesso Hepático Piogênico/diagnóstico , Abscesso Hepático Piogênico/terapia , Masculino , Pneumoperitônio/diagnóstico , Pneumoperitônio/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Ruptura Espontânea , Fatores de Tempo
6.
Medicine (Baltimore) ; 98(23): e15889, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169697

RESUMO

RATIONALE: Intestinal perforations due to blunt abdominal handlebar trauma are difficult to diagnose. This report presents a retrospective analysis of 3 patients with intestinal perforations due to abdominal bicycle handlebar trauma who were diagnosed via upright abdominal radiography. PATIENTS CONCERNS: All the patients lost their balance while riding a bicycle for leisure and had fallen on the handlebar tip. The patients were initially misdiagnosed at different-level health centers despite various radiologic investigations performed. DIAGNOSIS: The patients' intestinal perforations were diagnosed via plain upright abdominal X-ray radiography (UAXR) in our institution. INTERVENTIONS AND OUTCOMES: The children underwent exploratory laparotomy due to intestinal perforations. All the perforations were repaired either with primary closure or bowel resection and anastomosis with successful outcomes. LESSONS: Pneumoperitoneum due to intestinal perforation can be diagnosed via UAXR with appropriate patient positioning and timing. This case series shows that to accurately diagnose intestinal perforations, upright plain X-ray should be routinely performed, carefully evaluated, and repeated in patients with enduring abdominal complaints.


Assuntos
Traumatismos Abdominais/complicações , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Pneumoperitônio/diagnóstico , Ferimentos não Penetrantes/complicações , Adolescente , Ciclismo , Criança , Humanos , Perfuração Intestinal/diagnóstico por imagem , Masculino , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Radiografia Abdominal , Estudos Retrospectivos
10.
A A Pract ; 12(2): 33-36, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29985840

RESUMO

There are various causes of dysfunction of the diaphragm. We present a case of diaphragm dysfunction caused by an excessive pneumoperitoneum in a 65-year-old woman. Her abdomen became distended during endoscopic investigation and circulatory failure occurred. A computed tomography scan revealed excessive pneumoperitoneum. Urgent laparotomy was performed to repair gastric perforation. Tracheal extubation was successfully performed in the intensive care unit. After extubation, a paradoxical breathing pattern appeared in addition to tachypnea. A diagnosis of dysfunction of the bilateral diaphragm was made by ultrasonography. Although nasal high-flow cannula therapy was required for several days, she was discharged from our hospital 2 weeks after surgery without any further complications. We should keep in mind that diaphragm dysfunction after excessive abdominal extension can be a cause of respiratory failure.


Assuntos
Diafragma/diagnóstico por imagem , Endoscopia Gastrointestinal/efeitos adversos , Pneumoperitônio/diagnóstico , Idoso , Feminino , Humanos , Doença Iatrogênica , Laparotomia , Pneumoperitônio/etiologia , Choque/diagnóstico , Choque/etiologia , Ultrassonografia
11.
Turk J Pediatr ; 61(3): 460-465, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31916731

RESUMO

Wang YJ, Wang T, Xia SI, Zhang YC, Chen WB, Li B. Perforation of Meckel`s diverticulum in a very low birth weight neonate with severe pneumoperitoneum and review of literature. Turk J Pediatr 2019; 61: 460-465. Perforation is a rare complication of Meckel`s diverticulum (MD), but it could be severe, even life-threatening for pediatric patients. There is a paucity of data on etiology of perforation, as well as clinical manifestations, management and prognosis in very low birth weight (VLBW) neonates with perforated MD. We report a rare case of spontaneously perforated MD in a VLBW neonate presenting with severe pneumoperitoneum. To our knowledge, this is one of the earliest reported VLBW cases with this rare complication. Furthermore, we review relevant publications and summarize major characteristics of all VLBW cases previously reported in order to provide some practical experience and interesting issues for pediatricians. Perforated MD should be kept in mind when VLBW neonates present with pneumoperitoneum.


Assuntos
Doenças do Íleo/complicações , Recém-Nascido de muito Baixo Peso , Perfuração Intestinal/complicações , Divertículo Ileal/complicações , Pneumoperitônio/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Doenças do Íleo/diagnóstico , Recém-Nascido , Perfuração Intestinal/diagnóstico , Masculino , Divertículo Ileal/diagnóstico , Pneumoperitônio/diagnóstico , Radiografia Torácica , Ruptura Espontânea
14.
J Vet Emerg Crit Care (San Antonio) ; 28(6): 591-595, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30299567

RESUMO

OBJECTIVE: To describe the nonsurgical management of a cat with traumatic pneumoperitoneum. CASE SERIES SUMMARY: A 4-year-old cat was presented following vehicular polytrauma. Thoracic radiographs revealed 4 rib fractures, a scapular fracture, and pneumothorax. Abdominal ultrasound revealed a small volume of free abdominal fluid. Computed tomography showed a mild pneumoretroperitoneum and a pneumoperitoneum in the region of the porta hepatis. The cat was managed conservatively with close monitoring. Exploratory laparotomy was not pursued given patient stability and static serial imaging studies revealing no indications for surgical intervention. After 6 days, the pneumoperitoneum was no longer detectable. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first report of successful nonsurgical management of traumatic pneumoperitoneum in a cat.


Assuntos
Doenças do Gato/diagnóstico , Traumatismo Múltiplo/veterinária , Pneumoperitônio/veterinária , Animais , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/terapia , Gatos , Tratamento Conservador/veterinária , Diagnóstico Diferencial , Masculino , Pneumoperitônio/diagnóstico , Tomografia Computadorizada por Raios X/veterinária , Ultrassonografia/veterinária
16.
Surg Clin North Am ; 98(5): 915-932, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30243453

RESUMO

Pneumoperitoneum has a wide differential diagnosis and presents with varying degrees of severity; however, not all etiologies require operative intervention. It is imperative that all patients with this diagnosis are evaluated by a surgeon. A thorough history, physical examination, and workup, aimed at localization of the source of pneumoperitoneum will ultimately determine the necessary treatments, including the need for operative intervention. We aim to provide the reader with a working knowledge regarding the evaluation and treatment of patients with pneumoperitoneum.


Assuntos
Pneumoperitônio/diagnóstico , Pneumoperitônio/terapia , Diagnóstico Diferencial , Humanos , Pneumoperitônio/etiologia
18.
Obes Surg ; 28(9): 2976-2978, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30003474

RESUMO

Perforated duodenal ulcer following RYGB is an unusual clinical situation that may be a diagnostic challenge. Only 23 cases have previously been reported. We present five cases. The hallmark of visceral perforation, namely pneumoperitoneum, was not seen in three of the four cases that underwent cross sectional imaging. This is perhaps due to the altered anatomy of the RYGB that excludes air from the duodenum. Our cases had more free fluid than expected. The bariatric surgeon should not wait for free intraperitoneal air to suspect duodenal perforation after RYGB.


Assuntos
Úlcera Duodenal/etiologia , Derivação Gástrica/efeitos adversos , Úlcera Péptica Perfurada/etiologia , Pneumoperitônio/diagnóstico , Adulto , Colangiopancreatografia por Ressonância Magnética , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
20.
Adv Emerg Nurs J ; 40(2): 87-93, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29715250

RESUMO

Pneumoperitoneum, usually seen as free air under the diaphragm, is a finding that can be seen on plain abdominal radiographs, signifying a leakage of air, usually from a perforation in the gastrointestinal tract. There are several other potential pathways from other body compartments for air to enter the abdominal cavity. Pneumoperitoneum does not always signify bowel rupture, as it can also result from pneumomediastinum and pneumothorax, and in patients who are being mechanically ventilated. Patient history and physical examination can assist in a preliminary diagnosis before diagnostic imaging. Plain chest/abdominal radiograph or computed tomographic scan of the abdomen can be diagnostic of pneumoperitoneum. Surgical versus nonsurgical conservative observation is determined on the basis of the cause and amount of free air.


Assuntos
Pneumoperitônio/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Anamnese , Exame Físico , Pneumoperitônio/etiologia , Pneumoperitônio/enfermagem , Pneumoperitônio/terapia
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