Hospital: Hospital Universitario Basurto, Hospital Galdakao- Usansolo.
Ciudad:
Nº:
Aut@r o Autores: O. Gorriño Angulo, M. Sarabia Unibaso, M. Santamaria Peña, A. Legorburu Piedra, M. Udondo Gonzalez De Tánago, M. Gorriño Angulo.,
Presentación:
A 60 years old female, smoker, presented to the emergency department for abdominal pain, diarrhea, hypotension and cachexia. CT exam evidence multiple dilated small bowel loops with thinning and non- enhancing wall (paper-thin loops). The caecum, right and transverse colon present the same radiographic appearance, observing normal wall attenuation in the sigma – descending colon union. There is gas in intestinal wall (pneumatosis intestinalis) and gas in portal and mesenteric vein (pneumatosis portalis). Diffuse atherosclerotic disease with superior mesenteric artery occlusion and intrarterial distal gas. Adrenals are hyper-enhancing and collapsed inferior cava vein suggesting shock Patient died hours after laparotomy confirming diagnosis.
Discusión:
Acute mesenteric ischemia (AMI) is a rare life-threatening condition (1). Arterial embolism is the most frequent cause, accounting for 40%–50% of all AMI cases (1, 2). Early diagnosis of AMI is clinically difficult because nonspecific symptoms (3). Multiphase arterial and venous CT has become the diagnosis modality of choice with high sensitivity and specificity for AMI (1) and excludes other causes of acute abdominal pain (1, 2). Bowel wall thickening is the most common but nonspecific finding (1). Dilated small bowel loops (>3 cm) with paper-thin walls should raise strong suspicion for acute vascular compromise owing to thromboembolic disease (2). The absence of wall enhancement is a specific finding that indicates stop of arterial flow. If it persists, the bowel will infarct and perforated (1). Key findings indicating irreversible ischaemia include: paper-thin wall loops associated with adynamic ileus, pneumatosis intestinalis and portomesenteric venous gas, pneumoperitoneum, mesenteric fat stranding and ascites: and absence of bowel wall enhancement (1). Bowel wall thickening associated with a target or halo appearance may indicate reperfusion and favorable outcome (1). The prognosis for patients with AMI depends on the time to diagnosis and initiation of management (1).
Conclusión:
Acute mesenteric ischemia (AMI) is a rare life-threatening condition (1). Arterial embolism is the most frequent cause, accounting for 40%–50% of all AMI cases (1, 2). Early diagnosis of AMI is clinically difficult because nonspecific symptoms (3). Multiphase arterial and venous CT has become the diagnosis modality of choice with high sensitivity and specificity for AMI (1) and excludes other causes of acute abdominal pain (1, 2). Bowel wall thickening is the most common but nonspecific finding (1). Dilated small bowel loops (>3 cm) with paper-thin walls should raise strong suspicion for acute vascular compromise owing to thromboembolic disease (2). The absence of wall enhancement is a specific finding that indicates stop of arterial flow. If it persists, the bowel will infarct and perforated (1). Key findings indicating irreversible ischaemia include: paper-thin wall loops associated with adynamic ileus, pneumatosis intestinalis and portomesenteric venous gas, pneumoperitoneum, mesenteric fat stranding and ascites: and absence of bowel wall enhancement (1). Bowel wall thickening associated with a target or halo appearance may indicate reperfusion and favorable outcome (1). The prognosis for patients with AMI depends on the time to diagnosis and initiation of management (1).
Bibliografía:
– Kanasaki S, Furukawa A, Fumoto K, Hamanaka Y, Ota S, Hirose T, et al. Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. RadioGraphics 2018, 38: 945–961 – Sugi MD, Menias CO, Lubner MG, Bhalla S, Mellnick VM, Kwon MH, e