PICTURES IN DIGESTIVE PATHOLOGY

 

A cause of porto-mesenteric pneumatosis not secondary to intestinal ischemia

Causa de neumatosis porto-mesentérica no secundaria a isquemia intestinal

 

 

Cristina Soto-Montesinos, Roser Farré-Font and Mercé Güell-Farré

Department of General Surgery. Hospital Sant Joan de Deu. Fundació Althaia Xarxa Assistencial. Manresa, Barcelona. Spain

 

 

Case report

A 74-year-old patient with rheumatoid arthritis under treatment with corticosteroids and methotrexate was admitted to the Emergency Department with vomiting, diarrhea (more than 20 depositions during that day), abdominal pain, sweating and rectal bleeding. An abdominal computed tomography (CT) scan was performed that showed a mesenteric ischemia affecting a large segment of the small intestine and gastric walls (Figs. 1 and 2).

 

 

 

An exploratory laparotomy was carried out and the review of the whole abdominal cavity did not show signs of ischemia. The patient fully recovered with medical treatment and finally a coproculture was positive for rotavirus. A control abdominal CT scan six days after the exploratory laparotomy showed a resolution of portal gastric and intestinal pneumatosis (Fig. 3).

 

 

Discussion

The finding of portal pneumatosis may be related to multiples etiologies such as intestinal inflammatory diseases, intestinal infectious diseases, chemotherapy and radiotherapy treatments or advanced stages of intestinal ischemia. The gold standard for diagnosis is computed tomography, and once the findings are observed, proper differential diagnosis must be made to prevent unnecessary laparotomies.

 

References

1. Mancebo A, Álvarez-Hornia E, Rodríguez-Peláez M, et al. Indolent evolution of an episode of acute gastroenteritis complicated with portal pneumatosis. Rev Esp Enferm Dig 2010;102:557-9.         [ Links ]

2. Chien-Hua L, Jyh-Chelg Y, Huan-Fa H, et al. Pneumatosis intestinalis and hepatic-portal-mesenteric venous gas in intestinal ischemia. Rev Esp Enferm Digest 2007;99:96. DOI: 10.4321/S1130-01082007000200007.         [ Links ]

3. Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis ontestinalis. Arch Surg 2003;138(1):68-75.         [ Links ]