RESUMO
We have described two patients with abdominal actinomycosis, one with extensive intra-abdominal and thoracic disease mimicking metastatic carcinoma, and the other having the rarely described clinical entity of retroperitoneal disease without evidence of intra-abdominal involvement. Both patients responded well to appropriate therapy, but had unnecessary surgical procedures. The surgeon's role in cases of actinomycosis should be limited to the provision of a diagnosis when necessary.
Assuntos
Abdome , Actinomicose/diagnóstico por imagem , Actinomyces/isolamento & purificação , Actinomicose/tratamento farmacológico , Actinomicose/patologia , Actinomicose/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico , Penicilina G/uso terapêutico , Neoplasias Retroperitoneais/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Continuous jejunal feeding through needle catheter jejunostomy is generally well tolerated with minimal morbidity. Small bowel ischemia or infarction has not been reported in association with jejunal feedings. We describe five patients, each of whom had grossly normal small bowel at the time of insertion of needle catheter jejunostomy. All had episodes of hypotension during continuous jejunal feedings, and subsequently had abdominal distention. Upon abdominal exploration, two patients were found to have infarction of the jejunum and three had infarction of the entire small bowel. No evidence of major vascular occlusion or mechanical obstruction was found. Patients at high risk for hypoperfusion may not tolerate jejunal feedings during such episodes. It appears possible that feeding may increase the susceptibility of the gut to hypoperfusion.
