Diagnostic laparoscopy for pneumatosis intestinalis

Karabuğa, Türker; Yoldaş, Ömer; Özsan, İsmail; Yildirim, Utku Mahir; Ünal, Aydın

doi:10.1016/j.ajem.2014.04.042

Cited by 12 publications

(12 citation statements)

References 19 publications

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“…La neumatosis intestinal asintomática puede ser tratada de manera conservadora [18] Se ha descripto una buena respuesta al tratamiento de la neumatosis utilizando metronizadol y oxigeno hiperbárico [18] , demostrándose que la combinación de la terapia antibiótica más la dieta elemental, se ha asociado a muy buenos resultados en los casos leves de esta enfermedad. En los casos más graves, se recomienda la combinación de antibioticoterapia, dieta elemental y terapia con oxígeno hiperbárico, y la cirugía debe ser reservada como segunda línea de tratamiento, utilizándose para casos en los que se sospechan complicaciones (3% de los casos) como obstrucción intestinal, perforación o pacientes con diagnóstico previo de cáncer [20][21][22] . En aquellos casos con sospecha de complicaciones, pero sin certezas, la laparoscopía exploradora estaría indicada para posteriormente definir el diagnóstico y conducta [23] Conclusiones 1.…”

Section: Discussionunclassified

Caso clínico: pneumatosis intestinal

Cecenarro

Gómez

Gramática

2018

Rev Fac Cien Med Univ Nac Cordoba

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<div class="WordSection1">Objetivo: presentar un caso clínico reciente para aumentar el entendimiento, diagnóstico y tratamiento de la neumatosis intestinal, considerar las características distintivas de la enfermedad y así poder ampliar los conocimientos acerca del manejo de esta patología.Métodos: se presenta el caso de una paciente femenina de 65 años, originaria de Bolivia, con historial de artrosis, osteoporosis, asma y alergias a repetición. La paciente ingresa al Servicio de Cirugía N° 1 del HNC, en el mes de noviembre del 2015, con un cuadro clínico poco claro. En el transcurso de la internación se descubre la presencia de burbujas aéreas en la mucosa del colon y una lesión tumoral en duodeno. Rápidamente se comienza con el tratamiento y soporte adecuado para su estabilización. Se plantea una búsqueda bibliográfica y una puesta al día de las últimas actualizaciones en relación a esta patología. Se utilizaron buscadores médicos de renombre como PUBMED, UP TO DATE, VBS. Se seleccionaron una serie de artículos al respecto.La paciente citada en este trabajo ha otorgado el correspondiente consentimiento por escrito para la publicación anónima y con fines científicos de su infomación.Declaramos además la ausencia de financiamiento externo y conflictos de interés alguno.Conclusiones: se pudo concluir que el manejo en general debe ser conservador, excluyendo el caso de las complicaciones (oclusión, perforación) y a la sospecha de isquemia intestinal. La laparoscopía exploradora puede ser de ayuda para determinar la conducta apropiada. El tratamiento conservador incluye antibióticos, oxígeno hiperbárico y medidas de sostén.</div>

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Section: Discussionunclassified

Caso clínico: pneumatosis intestinal

Cecenarro

Gómez

Gramática

2018

Rev Fac Cien Med Univ Nac Cordoba

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“…In particular, collagen vascular disease is a risk factor for developing the condition [13] . Immunosuppression seems to be the common point of most of the diseases or their treatment related with PI [14] . The gentleman discussed in this case had a background of established systemic sclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, contradictory to his presentation, his initial CT scan was indicative of ischaemic changes and bowel perforation, which heavily influenced the decision to operate. A laparotomy was preferred over a laparoscopic approach; many authors advocate the use of laparoscopy when the patient is stable [14] . This would have been favourable as a more diagnostic and less invasive procedure but in view of the radiological findings there was concern regarding significant pathology.…”

Section: Discussionmentioning

confidence: 99%

A case report and approach to management in pneumatosis intestinalis

Jenkins

Courtney

Pope

et al. 2017

Annals of Medicine &Amp; Surgery

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Pneumatosis Intestinalis (PI) is an uncommon condition in which there is gas present within the wall of the gastrointestinal tract. PI is usually found in the large bowel, but can less commonly occur in the small bowel, and gas may be present in either the subserosal or submucosal layer of the intestine. Its unfamiliarity often means it is under-recognised and not considered as a differential diagnosis when assessing a patient with abdominal symptoms.The spectrum of conditions that produce PI is varied and ranges from the non-urgent to life-threatening. Early appreciation of the overall clinical picture is therefore paramount to enable the practitioner to distinguish between the benign to the fatal cases of PI and enable precise decision-making regarding its management.The challenge facing the clinician is twofold; firstly the accurate identification of the diagnosis of PI, as opposed to other causes of peritoneal gas and secondly judging whether operative or non-operative management should ensue. We present a case of a patient presenting on two separate occasions with PI, abdominal symptoms and radiological signs of acute abdominal pathology which demonstrates the wide spectrum of difficulties faced with this uncommon condition.

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“…Because our case had no signs of intestinal ischemia or peritoneal irritation such as lactic academia, we performed conservative therapy. If there is a suspicion of PI associated with intestinal ischemia, a laparoscopic exploration should be considered to rule out bowel perforation and ischemia [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A case of pneumatosis intestinalis during neoadjuvant chemotherapy with cisplatin and 5-fluorouracil for esophageal cancer†

Kasahara

Tsujimoto

Hiraki

et al. 2017

Journal of Surgical Case Reports

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Pneumatosis intestinalis (PI) is a relatively rare disease. A 70-year-old man with stage II squamous cell carcinoma of the middle thoracic esophagus was administered cisplatin plus 5-fluorouracil (CF) therapy as neoadjuvant chemotherapy. On Day 14 of the first course of CF therapy, he complained of acute abdominal pain. Computed tomography (CT) revealed PI of the entire colon and a small air bubble in the mesentery. A colonoscopy revealed that there was no finding suggestive of ischemia. Because there was no sign of peritoneal irritation, conservative treatment was selected. On Day 7 after PI diagnosis, CT indicated the disappearance of PI. The patient underwent a radical esophagectomy. Intraoperative laparoscopic findings showed the serosa of the colon to be intact. The patient was discharged without any complications. It is important to take into account that CF therapy may cause PI and that PI can be treated conservatively.

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Diagnostic laparoscopy for pneumatosis intestinalis

Cited by 12 publications

References 19 publications

Caso clínico: pneumatosis intestinal

Caso clínico: pneumatosis intestinal

A case report and approach to management in pneumatosis intestinalis

A case of pneumatosis intestinalis during neoadjuvant chemotherapy with cisplatin and 5-fluorouracil for esophageal cancer†

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