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Zhu H, Chen G, Liu S, Hong K, Wang H. Portal vein gas is a sign of intestinal necrosis after pesticide poisoning: a case report. J Int Med Res 2024; 52:3000605241240992. [PMID: 38597115 PMCID: PMC11010745 DOI: 10.1177/03000605241240992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 04/11/2024] Open
Abstract
Portal vein gas accumulation and intestinal pneumatosis are uncommon signs indicating a high mortality risk in cases of intestinal ischemic necrosis. However, the widespread use of computed tomography has led to an increase in detection of benign lesions. We report a case of portal vein gas accumulation resulting from organophosphorus pesticide poisoning. A male patient was brought to the hospital in a comatose state with bilateral pupils that measured 1.0 mm, and he showed shortness of breath and wet rattles in the lungs. A cholinesterase concentration of 214 U/L was detected on an auxiliary examination. The patient was diagnosed with organophosphorus pesticide poisoning and underwent mechanical ventilation, hemoperfusion, and continuous renal replacement therapy according to the poisoning guidelines. On the fifth day, considerable abdominal distension was observed. An abdominal computed tomography scan revealed dilation of the small bowel and ascending colon with fluid and gas accumulation, as well as gas within the intestinal wall and hepatic veins. Although portal vein gas and intestinal pneumatosis are a sign of mortality requiring immediate surgical intervention, an increasing number of benign cases suggests potential benefits of conservative treatment approaches.
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Affiliation(s)
- Huipeng Zhu
- Department of Vascular Surgery, the Affiliated People’s Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, Zhejiang Province, P. R. China
| | - Guozhong Chen
- Department of Intensive Care Unit, The Affiliated People’s Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, Zhejiang Province, P. R. China
| | - Shiyi Liu
- Department of Intensive Care Unit, The Affiliated People’s Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, Zhejiang Province, P. R. China
| | - Keyan Hong
- Department of Tumor, Ningbo Yinzhou District Traditional Chinese Medicine Hospital, 1228 jinda South Road, Ningbo City, Zhejiang Province, China
| | - Huajun Wang
- Department of Intensive Care Unit, The Affiliated People’s Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, Zhejiang Province, P. R. China
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Orts‐Porcar M, Ororbia A, Fina C, Herrería‐Bustillo VJ, Gómez‐Martín N, Barreiro‐Vázquez JD, González‐Rellán S, Anselmi C. Oesophageal pneumatosis: computed tomographic characteristics in three dogs (2018–2021). Vet Med Sci 2022; 8:2382-2389. [DOI: 10.1002/vms3.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | - Noemi Gómez‐Martín
- Hospital Veterinario Universidad Católica de Valencia, Valencia, Comunidad Valenciana Spain
| | - José Daniel Barreiro‐Vázquez
- Hospital Veterinario Universitario Rof Codina Facultade de Veterinaria, Universidade de Santiago de Compostela Lugo Galicia Spain
| | - Sonia González‐Rellán
- Departamento de Anatomía Produción Animal e Ciencias Clínicas Veterinarias Facultade de Veterinaria, Universidade de Santiago de Compostela Lugo Galicia Spain
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Lassandro G, Picchi SG, Romano F, Sica G, Lieto R, Bocchini G, Guarino S, Lassandro F. Intestinal pneumatosis: differential diagnosis. Abdom Radiol (NY) 2022; 47:1529-1540. [PMID: 32737548 DOI: 10.1007/s00261-020-02639-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/21/2020] [Accepted: 07/04/2020] [Indexed: 01/04/2023]
Abstract
Intestinal pneumatosis (IP) is an infrequent radiological sign defined as pathological gas infiltration into the bowel wall. It may be associated to different underlying clinical conditions-inflammatory bowel diseases, malignancies, chemotherapy, infections, immune deficiency status, trauma, intestinal ischemia, and necrosis-that are often related to emergency state and require a prompt diagnosis. All the imaging techniques, especially abdominal radiography and Computed Tomography, could detect the presence of IP and discern the forms related to emergency conditions. The differential diagnosis is essential to start an immediate clinical or surgical management and treatment. The aim of this article is to review the radiological features of IP in different illnesses, with particular attention to differential diagnosis.
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Affiliation(s)
- Giulia Lassandro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Naples, Italy
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Sun S, Zheng X, Zhang H, Han C, Zhao G. Hepatic portal venous gas associated with rapid infusion of postoperative early enteral nutrition after radical total gastrectomy. Nutrition 2022; 101:111685. [DOI: 10.1016/j.nut.2022.111685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/01/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
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Kakimoto Y, Matsushima Y, Tsuboi A, Seto Y, Osawa M. Nonocclusive mesenteric ischemia secondary to spinal cord injury: an autopsy case. Spinal Cord Ser Cases 2021; 7:37. [PMID: 33986243 DOI: 10.1038/s41394-021-00402-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a major direct cause of accidental death. Cervical SCI can lead to death in a short time period by neurogenic shock. Prompt vasopressor administration is recommended for patients with SCI accompanied by hypotension (systolic blood pressure < 90 mmHg). We herein present the first fatal case of nonocclusive mesenteric ischemia (NOMI) secondary to cervical SCI in a patient who suddenly died 1 week after an accidental fall. CASE PRESENTATION A 72-year-old man without medical history of cardiovascular disease suffered tetraplegia with a neurological level at C4 after a fall accident. He was fully conscious with stable respiratory ability, and the systolic blood pressure was maintained at >90 mmHg without vasopressor agents. High fever occurred 7 days after the accident and he died in the next morning. Autopsy revealed segmental intestinal necrosis from the ileum to the ascending colon, without mesenteric embolism, or severe arteriosclerosis. DISCUSSION This case implies that maintenance of >90-mmHg systolic blood pressure can insufficiently keep the blood flow to prevent NOMI, and the mean arterial blood pressure of >85 mmHg can be more plausible as suggested in the guideline. Monitoring the mean arterial blood pressure in acute SCI is useful not only for neurological recovery but also for the maintenance of vital intestinal perfusion.
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Affiliation(s)
- Yu Kakimoto
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan.
| | - Yutaka Matsushima
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Akio Tsuboi
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yoshihisa Seto
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Kanagawa, Japan
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Difference in Detection Rate of Portal Venous Gas via Computed Tomography and Ultrasonography in Pediatric Patients. Ultrasound Q 2019; 35:181-185. [DOI: 10.1097/ruq.0000000000000390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen H, Wu Q, Fang H, Liang B, Fang L. Intestinal necrosis cannot be neglected in a patient with hepatic portal vein gas combined with appendicitis: a rare case report and literature review. BMC Surg 2019; 19:17. [PMID: 30717721 PMCID: PMC6360744 DOI: 10.1186/s12893-019-0478-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/24/2019] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Haimin Chen
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
| | - Qingsong Wu
- Department of Hepatobiliary Surgery, Yuebei people‘s hospital, Shaoguan, Guangdong China
| | - Hongcai Fang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Jiujiang University, Jiujiang, Jiang xi China
| | - Bo Liang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
| | - Lu Fang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
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Hosokawa T, Takahashi H, Tanami Y, Sato Y, Hosokawa M, Oguma E. Detection of Intestinal Pneumatosis Location by Following Hyperechoic Foci in the Portal Vein Along Its Branches With Real-time Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:533-538. [PMID: 30051559 DOI: 10.1002/jum.14713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/26/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
Portal venous gas is occasionally encountered in children with intestinal pneumatosis, identified on real-time ultrasound imaging as hyperechoic foci with quick movement. The origin of the portal venous gas can be identified by following the hyperechoic foci along the branches of the portal vein, providing an estimate of the location of intestinal pneumatosis. This approach may be useful for predicting the patient's prognosis. Our report describes 2 cases of portal venous gas while estimating the area of intestinal pneumatosis, which were evaluated with real-time ultrasound.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Mayumi Hosokawa
- Department of Pediatrics, Saitama City Hospital, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Walczak R, Paek M, Suran J, Amory JT, Specchi S, Sanchez M. Radiography and ultrasonography of pneumatosis intestinalis in a cat. Vet Radiol Ultrasound 2018; 61:E26-E30. [DOI: 10.1111/vru.12635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/14/2018] [Accepted: 02/21/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Raelyn Walczak
- Department of RadiologyGulf Coast Veterinary Specialists Houston TX 77027
| | - Matthew Paek
- Department of RadiologySynergy Veterinary Imaging Partners Rockville MD 21029
| | - Jantra Suran
- Section of RadiologyUniversity of Pennsylvania Philadelphia PA 19104
| | - Joseph T. Amory
- Department of RadiologyIDEXX Telemedicine Consultants Clackamas OR 97015
| | - Swan Specchi
- Department of Clinical SciencesIstituto Veterinario di Novara Strada Provinciale 9 Granozzo con Monticello Italy
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Takahashi M, Goto S, Ueno T, Shima K, Inoue K, Douchi D, Nishina O, Naito H. Extreme dilatation of the interposed jejunal pouch after proximal gastrectomy associated with portal venous gas: A case report. Int J Surg Case Rep 2017; 37:244-247. [PMID: 28715720 PMCID: PMC5514623 DOI: 10.1016/j.ijscr.2017.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 12/31/2022] Open
Abstract
Dilatation of the interposed jejunal pouch developed after proximal gastrectomy. Shock state with portal venous gas was restored after conservative therapy. The pouch dilatation recurred soon after resuming oral ingestion. Resection of the pouch with R-Y esophagojejunostomy relieved the patient. Surgical intervention should be considered for refractory pouch dilatation.
Introduction The jejunal pouch interposition (JPI) after proximal gastrectomy (PG) was proposed as a reconstructive procedure to provide a gastric reservoir substitute and prevent postgastrectomy syndrome. However, food residue remaining in some of the pouches resulted in the adverse effect of abdominal bloating, thereby body weight loss. Here, we report a rare case with an extreme dilation of the interposed jejunal pouch (JP) 8 years after PG, requiring pouch resection. Presentation of case A 65-year-old-man who had undergone PG with an inverted U-shaped JPI for early gastric cancer 8 years previously, suffered from shock after right hip joint implantation. Abdominal enhanced CT scan revealed an extremely dilated JP accompanied by portal venous gas. After 5 months of conservative therapy, he underwent resection of the JP and gastric remnant with Roux-en-Y esophagojejunostomy reconstruction. After the operation, the patient has remained in good health for over 3 years. Discussion and conclusion Long-term operative outcome following pouch operation for gastric cancer still remains controversial. Surgical intervention should be considered when we encounter patients who have refractory pouch dilatation after surgery for gastric cancer.
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Affiliation(s)
- Michinaga Takahashi
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Shinji Goto
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Tatsuya Ueno
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Kentaro Shima
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Koetsu Inoue
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Daisuke Douchi
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Orie Nishina
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
| | - Hiroo Naito
- Department of Surgery, South Miyagi Medical Center, 38-1 Aza Nishi, Ogawara, Shibata-gun, Miyagi, 989-1253 Japan.
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Nevins EJ, Moori P, Ward CSJ, Murphy K, Elmes CE, Taylor JV. A rare case of ischaemic pneumatosis intestinalis and hepatic portal venous gas in an elderly patient with good outcome following conservative management. Int J Surg Case Rep 2016; 25:167-70. [PMID: 27376775 PMCID: PMC4932613 DOI: 10.1016/j.ijscr.2016.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 12/20/2022] Open
Abstract
PI and HPVG caused by ischaemia usually results in death if conservatively managed. A 93 year old male survived this despite non-operative management. Aggressive surgical intervention is not always in the patients’ best interest. Further work is needed to identify patients who may survive conservative treatment.
Introduction Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are typically associated and are likely to represent a spectrum of the same disease. The causes of both entities range from benign to life-threatening conditions. Ischaemic causes are known to be fatal without emergency surgical intervention. Presentation of case In this case a 93 year old male experienced acute abdominal pain radiating to his back, with nausea and vomiting and a 2-week history of altered bowel habit. Examination revealed abdominal tenderness and distension. He had deranged white cell count (WCC) and renal function. Computed tomography (CT) revealed PI with associated HPVG. The cause was due to ischaemic pathology. The patient was managed conservatively with antibiotics and was discharged 7 days later with resolution of his abdominal pain and WCC. Discussion The pathogenesis of HPVG secondary to PI is poorly understood but usually indicates intestinal ischaemia, thought to carry a mortality of around 75%. HPVG in the older patient usually necessitates emergency surgery however this is not always in the patient’s best interest. Conclusion There are few reported cases of patient survival following conservative management of PI and HPVG secondary to ischaemic pathology. This case demonstrates the possibility of managing this condition without aggressive surgical intervention especially when surgery would likely result in mortality due to frailty and morbidity. Further work is required to identify suitable patients.
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Affiliation(s)
- E J Nevins
- Emergency General Surgery and Trauma Unit, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom.
| | - P Moori
- University of Liverpool Medical School, Liverpool, England L69 3BX, United Kingdom
| | - C S J Ward
- Emergency General Surgery and Trauma Unit, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
| | - K Murphy
- Emergency General Surgery and Trauma Unit, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
| | - C E Elmes
- Emergency General Surgery and Trauma Unit, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
| | - J V Taylor
- Emergency General Surgery and Trauma Unit, University Hospital Aintree, Liverpool, England L9 7AL, United Kingdom
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