Hospital: H.U de Móstoles.
Nº: C2019-480
Aut@r o Autores: Y. Del Rosario Vega, J. Sánchez Dalmau, M. García De Las Heras, C. Córdova Muñoz, S. Sánchez Gutierrez, E. Izquierdo Milla.
Presentación
A 91-year-oldwoman with medical history of acute myocardial infarction and atrial fibrillation (AF) she was brought to the emergency room complaining of diffuse abdominal pain in the last 48 hours, associated with two episode of vomiting. There was with no history of recent abdominal surgery. On the physical exam she had diffuse abdominal tenderness without peritoneal signs. Blood pressure: 90/55, Pulse: 94pm. Laboratory tests showed leukocytosis 15,000, hyperglycemia 195, Na 134, K 3,5, lactate 3.7. The remained laboratory tests were within the normal limits, included urine test. Abdominal Xray revealed findings suggestive of pneumatosis in small bowel loops and pneumoperitoneum as confirmed in the CT-scan that also showed portal pneumatosis (PN) and bladder pneumatosis (BN). Despite the presence of signs of extensive atherosclerotic disease, permeability of the visceral vascular system was observed. Conservative treatment was decided with clinical improvement of the patient and practical resolution of the radiological findings in just four days. Another similar episode occurred a few months later with equally favorable resolution.
Discusión
Differential radiological diagnosis included: