Pneumatosis Intestinalis and Aeroportia: A Case Report.

The presence of pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) is associated with severe diseases. A 71-year-old man was admitted to the emergency department with complaints of severe and persistent nausea, vomiting, and diffuse abdominal pain that had been present for one week. An abdominal computed tomography (CT) showed aeroportia and PI, suggesting intestinal ischemia. Despite refusing an emergent exploratory laparotomy, the patient received medical treatment. However, due to the advanced stage of the condition, the medical treatment was ineffective, and the patient died a few hours later.

A Rare and Severe Cause of Abdominal Pain in a Hemodialysis Patient.

Pneumatosis intestinalis (PI) and aeroportia have been rarely described in hemodialysis patients. We present a case of a 64-year-old woman on regular hemodialysis who presented with abdominal pain, vomiting, and diarrhea. Abdominal CT showed pneumatosis intestinalis and aeroportia suggestive of ischemic abnormalities. In this case, given the absence of transmural necrosis or bowel perforation, aeroportia seemed to be caused by nonocclusive mesenteric ischemia (NOMI), an increasingly recognized complication in hemodialysis patients. The patient was proposed for emergent exploratory laparotomy; however, she had a fatal outcome. Hemodialysis-dependent patients should be considered at risk of the "low-flow syndrome" of mesenteric arterial circulation. Prevention is crucial, and early detection of these entities is important for prompt diagnosis and management of mesenteric ischemia.

Gastric pneumatosis and concurrent aeroportia due to gastric outlet obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Gastric pneumatosis with concurrent hepatic portal vein gas is an extremely rare condition in the adult population. It can be idiopathic or associated with well-known etiologies. Gastric outlet obstruction can progressively inflate the stomach and cause pneumatosis. Regarding abdominal signs and the presence of acute abdomen, management varies from just conservative to emergent surgical interventions. CASE PRESENTATION: We introduce an adult patient who presented to our hospital with weakness and dyspnea. After initial measures, unexpectedly we found intraabdominal free gas, concurrent gastric pneumatosis, and aeroportia. Due to the absence of positive abdominal signs, the patient was treated successfully without any surgical or endoscopic interventions. DISCUSSION: Gastric outlet obstruction is a well-known cause of gastric pneumatosis. Progressive dilation of the stomach due to pyloric stenosis is well-described both in infants and adult populations. CONCLUSION: In stable patients, gastric drainage and correction of electrolyte disturbance are the only required treatment. However endoscopic and surgical interventions should be considered in unstable patients or those developing acute abdomen.

[Right heart intra-cavitar echogenic foci following mesenteric ischemia]. / L'image du mois. Hyper-échogénicités intra-cavitaires cardiaques droites au décours d'une ischémie mésentérique.

This clinical case demonstrates the pivotal role of repeated cardioechography in both diagnosis and follow-up of well selected ER and ICU inpatients. We report the finding of right heart intra-cavitar hyper-echogenic foci ultimately leading to the diagnosis of mesenteric ischemia.

Ce cas clinique démontre l'importance de l'échocardiographie dans le diagnostic et le suivi de patients dûment sélectionnés aussi bien dans les services d'Urgences que de Soins intensifs. Nous rapportons la mise en évidence d'images hyper-échogènes au sein des cavités cardiaques droites aboutissant finalement au diagnostic d'une ischémie mésentérique.

Perigastric and Portal Venous Gas Induced by Vomiting.

Teaching point: Portal venous gas is often associated with severe abdominal pathologies, but may be also encountered in less dramatic conditions such as vomiting.

Aeroportia and acute abdominal pain: ischemic bowel necrosis.

Pneumatosis intestinalis and aeroportia are typical findings of mesenteric ischemia. The second carries a worse prognosis than the former. We report the case of a patient presenting with acute abdominal pain and acidosis after admission to the coronary unit for myocardial infarction. An emergent abdominal CT scan showed aeroportia. Laparotomy confirmed extended bowel necrosis. Aeroportia is a typical feature of ischemic bowel necrosis, often associated with advanced disease and bad prognosis. In the presence of acute abdominal pain, aeroportia should be considered as a sign of ischemic bowel necrosis. Emergent laparotomy is warranted.