Trombose mesentérica como complicação da colecistectomia videolaparoscópica / Intestinal ischaemia after laparoscopic cholecystectomy
Rev. Col. Bras. Cir
;
25(4): 283-4, jul.-ago. 1998.
Artículo
en Portugués
| LILACS
| ID: lil-255432
RESUMO
Intestinal complications after laparoscopic cholecystectomy are rare and usually caused by direct injury sustained on trocar insertion. However, intestinal ischaemia has been reported as an unusual complication of the pneumoperitoneum. We describe a 55-years-old patient who underwent an uneventful laparoscopic cholecystectomy after an episode of acute cholecystitis. Initial recovery was complicated by development of increasing abdominal pain which led to open laparotomy on day 2. Gangrene of the distal ileum and right-sided colon was detected and small bowel resection with right colectomy and primary anastomosis was performed. Histological examination of the resected ileum showed features of venous hemorragic infarction and trombosis. In view of the proximity of the operation it is assumed that ileal ischaemia was precipitated by carbon dioxide pneumoperitoneum. Some studies have been demonstrated that, within 30 minutes of establishing a pneumoperitoneum at an intraabdominal pressure of 16mmHg, cardiac output, blood flow in the superior mesenteric artery and portal vein decrease progressively. Carbon dioxide pneumoperitoneum may lead to mechanical compression of the splanchnic veins and mesenteric vasoconstriction as a result of carbon dioxide absortion. The distribution of the ischaemic segment of intestine is also unusual as the most precarious blood supply is traditionally at the splenic flexure of the colon. It has been suggested that intermittent decompression of the abdomen reduces the risk of mesenteric ischaemia during pneumoperitoneum especially in patients with predisposing clinical features for arteriosclerosis intestinal. In present patient was observed intestinal venous infarction what remains unclear but we think the carbon dioxide pneumoperitoneum have been related to it
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Colecistectomía Laparoscópica
/
Intestinos
/
Isquemia
Límite:
Humanos
/
Masculino
Idioma:
Portugués
Revista:
Rev. Col. Bras. Cir
Asunto de la revista:
Cirugía General
Año:
1998
Tipo del documento:
Artículo
Similares
MEDLINE
...
LILACS
LIS