1
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Liu A, Shen J, Long L, Shi X, Wen Q, Pan Z. Hepatic portal venous gas initially manifesting as severe shock: a case series. J Int Med Res 2024; 52:3000605241239469. [PMID: 38603615 PMCID: PMC11010767 DOI: 10.1177/03000605241239469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
Hepatic portal venous gas is often referred to as the "sign of death" because it signifies a very poor prognosis if appropriate treatments are not promptly administered. The etiologies of hepatic portal venous gas are diverse and include severe complex abdominal infections, mesenteric ischemia, diving, and complications of endoscopic surgery, and the clinical manifestations are inconsistent among individual patients. Thus, whether emergency surgery should be performed remains controversial. In this report, we present three cases of hepatic portal venous gas. The patients initially exhibited symptoms consistent with severe shock of unknown etiology and were treated in the intensive care unit upon admission. We rapidly identified the cause of each individual patient's condition and selected problem-directed intervention measures based on active organ support, antishock support, and anti-infection treatments. Two patients recovered and were discharged without sequelae, whereas one patient died of refractory infection and multiple organ failure. We hope that this report will serve as a valuable reference for decision-making when critical care physicians encounter similar patients.
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Affiliation(s)
- Anwei Liu
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Jiao Shen
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Liansheng Long
- Department of General Surgery, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Xuezhi Shi
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Qiang Wen
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Zhiguo Pan
- Emergency Department, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
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2
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Furuta T, Fujiwara M, Motonaga T, Matsufuji H, Tateishi H, Nakada S, Kanagawa T, Uchida M. Ultrasound and computed tomography findings of hepatic portal venous gas associated with acute appendicitis in a paediatric patient: A case report. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:67-70. [PMID: 38314018 PMCID: PMC10836226 DOI: 10.1177/1742271x231195752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024]
Abstract
Introduction Hepatic portal venous gas is a rare and life-threatening condition characterised by the presence of gas in the portal vein. Hepatic portal venous gas is frequently associated with intestinal ischaemia and necrosis. We present the case of a paediatric patient with acute appendicitis with hepatic portal venous gas detected using ultrasonography. Case report A 5-year-old boy was admitted to our hospital with a respiratory tract infection. The boy started vomiting on day 2 of hospitalisation. He did not complain of any symptoms due to developmental retardation. We performed bedside point-of-care ultrasound, which detected hepatic portal venous gas, although the appendix could not be detected due to an acoustic shadow associated with bowel gas. Contrast-enhanced computed tomography revealed perforated appendicitis and pneumatosis intestinalis associated with paralytic ileus. An emergency laparoscopic appendectomy was performed. He was discharged on day 25 of hospitalisation after antibiotic therapy. Discussion The present case suggests that the mechanism of hepatic portal venous gas was paralytic ileus, which caused gas-forming bacterial proliferation. The gas produced by bacteria and/or the gas-forming bacteria entered the bowel wall, which caused pneumatosis intestinalis. The bubbles in the intestinal wall floated in the portal system and were detected as hepatic portal venous gas. Perforated appendicitis and paralytic ileus seemed to be caused by a delayed diagnosis of appendicitis. The point-of-care ultrasound examination was useful for detecting hepatic portal venous gas and for helping establish the diagnosis of appendicitis. Conclusion Hepatic portal venous gas is a rare finding associated with appendicitis in children. In addition, point-of-care ultrasound is useful for detecting hepatic portal venous gas in paediatric patients.
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Affiliation(s)
- Takashi Furuta
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Mayu Fujiwara
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Takahiro Motonaga
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Hironori Matsufuji
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Hiroshi Tateishi
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
| | - Soichi Nakada
- Department of Pediatric Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Tsutomu Kanagawa
- Department of Pediatric Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Masashi Uchida
- Department of Pediatrics, Tokuyama Central Hospital, Japan Community Healthcare Organization, Shunan, Japan
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3
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Chen Z, Zhang C, Liu C, Xiao X, Lai X, Wang Y, Zhu G, Lv J, Wang D, Yu X. Hepatic venous gas secondary to pulmonary barotrauma: rat model study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00755-7. [PMID: 38147284 DOI: 10.1007/s12024-023-00755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
Intrahepatic gas (IHG) is commonly observed during early postmortem examinations of humans with upper or lower airway obstructions. We conducted a study to test the hypothesis that intrapulmonary gas could retrogradely spread to the hepatic vein following pulmonary barotrauma (PB). To establish a rat model of pulmonary barotrauma, we utilized a controllable pressure-vacuum pump to apply airway pressure (40, 60, or 80 mmHg). The rats were dissected directly at the end of the experiment, and histological analysis was performed through microscopic examination of the rats. Additionally, the rats were ventilated with meglumine diatrizoate under pressures of 160 and 250 mmHg to observe the signal dynamic diffusion using X-ray fluoroscopy examination. Rats exhibited classical changes associated with PB, such as alveolar rupture, pulmonary interstitial emphysema, and hemorrhage, as well as IHG characterized by the presence of gas in the hepatic vein and hepatic sinusoids. Air emboli were not observed in the liver in any of the 40 mmHg groups. However, they were observed in the liver in the 60 and 80 mmHg groups, the amount and size of air emboli in the 80 mmHg group were greater than those in the 60 mmHg group (p < 0.05). The 80 mmHg group presented radial grape-like bubbles in the centrilobular portion of the liver accompanied by congestion in the peripheral region of the hepatic lobule. X-ray fluoroscopy examination revealed a gradual enhancement of dynamic contrast medium signals from the lung to the inferior vena cava and then to the liver. Our findings indicate that pulmonary barotrauma can lead to the retrograde spread of intrapulmonary gas to the hepatic vein. When it is clear that no decomposition of the body has occurred, the presence of IHG serves as a novel indicator for the diagnosis of obstructive pulmonary disease or obstruction in the upper or lower airway.
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Affiliation(s)
- Zeyu Chen
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Chuanqi Zhang
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
- Department of Laboratory Medicine, Urban Vocational College of Sichuan, Chengdu, Sichuan Province, 610110, People's Republic of China
| | - Chao Liu
- Jinjiang Public Security Bureau, Jinjiang, Fujian Province, 362200, People's Republic of China
| | - Xudong Xiao
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Xiaoping Lai
- Guangdong Medical University, Guangzhou, Guangdong Province, 523808, People's Republic of China
| | - Yu Wang
- Fujian Mingjian Forensic Institute, Jinjiang, Fujian Province, 362200, People's Republic of China
| | - Guanghui Zhu
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Junyao Lv
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Dian Wang
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China
| | - Xiaojun Yu
- Department of Forensic Pathology, National Key Disciplines, Collaborative and Creative Center, Shantou University Medical College, Shantou, Guangdong Province, 515041, People's Republic of China.
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4
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Suto K, Hikichi T, Shioya Y, Ishizaki N, Saito S, Nakamura J, Kobayakawa M, Ohira H. A healthy young patient with hepatic portal vein gas due to acute gastric dilatation: a case report. Clin J Gastroenterol 2023:10.1007/s12328-023-01797-8. [PMID: 37040045 DOI: 10.1007/s12328-023-01797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
Hepatic portal vein gas (HPVG) is caused by the influx of gastrointestinal gas into the intrahepatic portal vein as a result of gastrointestinal wall fragility due to ischemia or necrosis. Gastrointestinal tract necrosis is fatal in severe cases. We observed a case of food intake-induced acute gastric dilatation (AGD) in a healthy young male who developed HPVG and underwent conservative treatment. A 25-year-old male presented to our hospital with epigastric pain and nausea the day after excessive food intake. Computed tomography (CT) revealed gas along the intrahepatic portal vein and marked gastric dilatation with large food residue. AGD-induced HPVG was considered. Esophagogastroduodenoscopy (EGD) was not performed at this stage because of the risk of HPVG and AGD exacerbation, and the patient was followed up with intragastric decompression via a nasogastric tube. Food residue and approximately 2 L of liquid without blood were vomited 1 h after the nasogastric tube placement. His symptoms improved after the vomiting episode. An EGD was performed 2 days after undergoing CT. Endoscopic findings revealed extensive erosions and the presence of a whitish coat extending from the fornix to the lower body of the stomach, indicating AGD. HPVG disappeared on the CT scan taken during EGD. Thereafter, symptom relapse and HPVG recurrence were not observed.
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Affiliation(s)
- Kazuto Suto
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yasuo Shioya
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
| | - Natsuki Ishizaki
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Saito
- Department of Gastroenterology, Jusendo General Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masao Kobayakawa
- Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Medical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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5
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Sharp J, Chuang K. Benign Pneumatosis Intestinalis: A Case Report and Review of the Literature. Fed Pract 2022; 39:281-285. [PMID: 36404938 PMCID: PMC9648604 DOI: 10.12788/fp.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pneumatosis intestinalis is the presence of gas within the walls of the intestine on imaging and has variable clinical significance, ranging from an incidental finding to a harbinger of intra-abdominal catastrophe. There are multiple mechanisms by which this radiographic finding develops, including bacterial gas production, increased intraluminal pressure within the gastrointestinal tract, mechanical disruption of the gut mucosa, and tracking of pulmonary gas along the mesenteric vasculature. CASE PRESENTATION We present the case of a 61-year-old male veteran who had sustained a remote anoxic brain injury resulting in chronic dependence on a gastrostomy tube for enteral nutrition, found incidentally to have pneumatosis intestinalis without signs of intra-abdominal catastrophe. CONCLUSIONS Appropriate interpretation of this finding can lead to life-saving interventions and avoid unnecessary surgical procedures.
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Affiliation(s)
| | - Kelley Chuang
- Greater Los Angeles Veterans Affairs Healthcare System, California
- David Geffen School of Medicine at University of California, Los Angeles
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6
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Klebsiella oxytoca Complex: Update on Taxonomy, Antimicrobial Resistance, and Virulence. Clin Microbiol Rev 2021; 35:e0000621. [PMID: 34851134 DOI: 10.1128/cmr.00006-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Klebsiella oxytoca is actually a complex of nine species-Klebsiella grimontii, Klebsiella huaxiensis, Klebsiella michiganensis, K. oxytoca, Klebsiella pasteurii, Klebsiella spallanzanii, and three unnamed novel species. Phenotypic tests can assign isolates to the complex, but precise species identification requires genome-based analysis. The K. oxytoca complex is a human commensal but also an opportunistic pathogen causing various infections, such as antibiotic-associated hemorrhagic colitis (AAHC), urinary tract infection, and bacteremia, and has caused outbreaks. Production of the cytotoxins tilivalline and tilimycin lead to AAHC, while many virulence factors seen in Klebsiella pneumoniae, such as capsular polysaccharides and fimbriae, have been found in the complex; however, their association with pathogenicity remains unclear. Among the 5,724 K. oxytoca clinical isolates in the SENTRY surveillance system, the rates of nonsusceptibility to carbapenems, ceftriaxone, ciprofloxacin, colistin, and tigecycline were 1.8%, 12.5%, 7.1%, 0.8%, and 0.1%, respectively. Resistance to carbapenems is increasing alarmingly. In addition to the intrinsic blaOXY, many genes encoding β-lactamases with varying spectra of hydrolysis, including extended-spectrum β-lactamases, such as a few CTX-M variants and several TEM and SHV variants, have been found. blaKPC-2 is the most common carbapenemase gene found in the complex and is mainly seen on IncN or IncF plasmids. Due to the ability to acquire antimicrobial resistance and the carriage of multiple virulence genes, the K. oxytoca complex has the potential to become a major threat to human health.
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7
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Le J, Ji H, Zhou X, Wei X, Chen Y, Fu Y, Ma Y, Han Q, Sun Y, Gao Y, Wu H. Pharmacology, Toxicology, and Metabolism of Sennoside A, A Medicinal Plant-Derived Natural Compound. Front Pharmacol 2021; 12:714586. [PMID: 34764866 PMCID: PMC8576406 DOI: 10.3389/fphar.2021.714586] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022] Open
Abstract
Sennoside A (SA) is a natural dianthrone glycoside mainly from medicinal plants of Senna and Rhubarb, and used as a folk traditional irritant laxative and slimming health food. Accumulating evidences suggest that SA possesses numerous pharmacological properties, such as laxative, anti-obesity, hypoglycemic, hepatoprotective, anti-fibrotic, anti-inflammatory, anti-tumor, anti-bacterial, anti-fungal, anti-viral, and anti-neurodegenerative activities. These pharmacological effects lay the foundation for its potential application in treating a variety of diseases. However, numerous published studies suggest that a long-term use of SA in large doses may have some adverse effects, including the occurrence of melanosis coli and carcinogenesis of colon cancer, thereby limiting its clinical use. It remains to be established whether SA or its metabolites are responsible for the pharmacological and toxicity effects. In this review, the latest advances in the pharmacology, toxicology, and metabolism of SA were summarizedbased on its biological characteristics and mechanism.
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Affiliation(s)
- Jiamei Le
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai Key Laboratory of Molecular Imaging, Collaborative Innovation Center for Biomedicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Houlin Ji
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoxiao Zhou
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xindong Wei
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Nanjing University of Chinese Medicine Affiliated 81st Hospital, Nanjing, China
| | - Yifan Chen
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai Key Laboratory of Molecular Imaging, Collaborative Innovation Center for Biomedicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yi Fu
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai Key Laboratory of Molecular Imaging, Collaborative Innovation Center for Biomedicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yujie Ma
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai Key Laboratory of Molecular Imaging, Collaborative Innovation Center for Biomedicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qiuqin Han
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai Key Laboratory of Molecular Imaging, Collaborative Innovation Center for Biomedicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yongning Sun
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yueqiu Gao
- Department of Liver Diseases, Central Laboratory, Institute of Clinical Immunology, ShuGuang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Laboratory of Cellular Immunity, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hailong Wu
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.,Shanghai Key Laboratory of Molecular Imaging, Collaborative Innovation Center for Biomedicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
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8
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Zorzetti N, Lauro A, Ruffato A, D'Andrea V, Ferruzzi L, Antonacci N, Tranchino RM. Gas in the Portal Vein: An Emergency or Just Hot Air? Dig Dis Sci 2021; 66:3290-3295. [PMID: 34189669 DOI: 10.1007/s10620-021-07126-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction.
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Affiliation(s)
- N Zorzetti
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy.
| | - A Lauro
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - A Ruffato
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - L Ferruzzi
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - N Antonacci
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
| | - R M Tranchino
- Department of General Surgery, "Ospedale Civile Umberto I", Lugo, Ravenna, Italy
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9
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Kobayashi E, Kan Y, Kamiya T, Kumagai A, Uhara H. Case of pneumatosis cystoides intestinalis with pemphigus vulgaris. J Dermatol 2020; 47:e412-e413. [DOI: 10.1111/1346-8138.15544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eri Kobayashi
- Department of Dermatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Yuji Kan
- Department of Dermatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Takafumi Kamiya
- Department of Dermatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Ayako Kumagai
- Department of Dermatology Sapporo Medical University School of Medicine Sapporo Japan
| | - Hisashi Uhara
- Department of Dermatology Sapporo Medical University School of Medicine Sapporo Japan
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10
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Liu C, Wu CH, Zheng XD, Liu JP, Li CL, Zhao JY, Lan Q, Zhou WL, Li WB. Hepatic portal venous gas: A case report and analysis of 131 patients using PUBMED and MEDLINE database. Am J Emerg Med 2020; 45:506-509. [PMID: 32739095 DOI: 10.1016/j.ajem.2020.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Hepatic portal pneumatosis has a high mortality rate, and whether surgical intervention is necessary remains controversial. This experiment retrospectively analyzed the etiology, treatment methods and prognosis of adult patients with hepatoportal pneumocele to provide a theoretical basis for the treatment of this disease. METHODS We analyzed the clinical symptoms and post-treatment of a 43-year-old male patient with HPVG admitted to hospital. We retrieved adult non-iatrogenic HPVG cases with complete clinical data in PUBMED, and MEDLINE and other databases were retrieved for analysis, and summarized the pathogenesis, clinical symptoms, pathogenesis, pathogenesis and prognosis of different treatment schemes were summarized. RESULTS The main etiology of HPVG are intestinal ischemia (27%), severe enteritis/intestinal perforation/intestinal fistula (16%), intestinal obstruction (7%), abdominal infection (7%), gastric diseases (11%), appendicitis and its complications (5%), acute hemorrhage or necrotizing pancreatitis (5%), Crohn's disease and its complications (4%), trauma (traffic accidents, falls) (2%), diverticulitis and perforation (6%), nephrogenic diseases (4%), spontaneous pneumohepatic portal vein (2%), other reasons (4%). And after analysis, we found that the survival rate of patients treated by surgery was 40.5% and the mortality rate was 19.1%, the difference between the two was significant. CONCLUSIONS Etiology should be actively explored and surgical treatment is necessary.
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Affiliation(s)
- Chun Liu
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Chang-Hui Wu
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Xiang-De Zheng
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China.
| | - Jin-Ping Liu
- Dazhou Vocational College of Chinese Medicine, Dazhou, Sichuan, China
| | - Chang-Long Li
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Jie-Yu Zhao
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Qing Lan
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Wen-Lai Zhou
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Wen-Bin Li
- Intensive Care Unit, Dazhou Central Hospital, Dazhou, Sichuan, China
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11
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Muhammad Nawawi KN, Abd Samat AH, Nik Fuad NF, Yi LL. Pneumatosis intestinalis: An important radiological clue in a case of missed perforated appendicitis. Turk J Emerg Med 2020; 20:86-89. [PMID: 32587928 PMCID: PMC7305666 DOI: 10.4103/2452-2473.278560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/07/2019] [Indexed: 01/17/2023] Open
Abstract
Pneumatosis intestinalis (PI) is a rare radiological finding, characterized by the presence of gas in the bowel wall. It has a wide spectrum of possible underlying diagnosis ranging from benign to life-threatening conditions. We present a case of a previously healthy male who was initially presented with missed diagnosis of acute appendicitis which had led to perforated appendix. Failure to recognize the significance of PI and its correlation with other clinical information had caused the delay in his surgical intervention. Fortunately, the patient made a steady recovery and was discharged well. It is important to have a high clinical suspicion of life-threatening conditions whenever patients presented with a radiological clue of PI. Failure to incorporate this finding with other clinical clues might lead to devastating consequences and delay the necessary treatment.
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Affiliation(s)
- Khairul Najmi Muhammad Nawawi
- Department of Medicine, Gastroenterology Unit,The National University of Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Azlan Helmy Abd Samat
- Department of Emergency, Faculty of Medicine, The National University of Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Nik Farhan Nik Fuad
- Department of Radiology, Faculty of Medicine, The National University of Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Lim Li Yi
- Department of Surgery, Faculty of Medicine, The National University of Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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12
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Heda RP, Savage Y, Nair SP, Verma R. Enterococcus casseliflavus, Streptococcus equinus and Klebsiella oxytoca septicaemia associated with perinephric haematoma in a post-liver transplant patient with allograft cirrhosis. BMJ Case Rep 2019; 12:12/8/e230096. [PMID: 31466981 DOI: 10.1136/bcr-2019-230096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Liver transplant recipients are immunocompromised by the virtue of being on immunosuppressive agents which put them at risk of having infections from unusual and even multiple concomitant pathogens. We present a case of a 39-year-old man who developed septicaemia with Enterococcus casseliflavus, Streptococcus equinus and Klebsiella oxytoca in the setting of perinephric haematoma which resulted following a kidney biopsy performed to evaluate his nephrotic range proteinuria. E. casseliflavus has been known to cause infections in patients with liver disease/cirrhosis; however, simultaneous infection with S. equinus and K. oxytoca along with E. casseliflavus has never been reported earlier in post-transplant state.
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Affiliation(s)
| | - Yolanda Savage
- Microbiology, Methodist University Hospital, Memphis, Tennessee, USA
| | - Satheesh P Nair
- Transplant Hepatology, Methodist University Hospital, UTHSC College of Medicine Memphis, Memphis, Tennessee, USA
| | - Rajanshu Verma
- Transplant Hepatology, Methodist University Hospital, UTHSC College of Medicine Memphis, Memphis, Tennessee, USA
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