Pneumatosis Cystoides Intestinales and Portomesenteric Venous Gas following Anticholinesterase Pesticide Poisoning
Journal of The Korean Society of Clinical Toxicology
; : 56-59, 2017.
Article
in English
| WPRIM (Western Pacific)
| ID: wpr-61398
Responsible library:
WPRO
ABSTRACT
Pneumatosis cystoides intestinalis and portomesenteric venous gas are uncommon radiological findings, but are found commonly in cases of bowel ischemia, or as a result of various non-ischemic conditions. A 72-year-old man visited an emergency center with altered mental status 2 hours after ingestion of an unknown pesticide. On physical examination, he showed the characteristic hydrocarbon or garlic-like odor, miotic pupils with no response to light, rhinorrhea, shallow respiration, bronchorrhea, and sweating over his face, chest and abdomen. Laboratory results revealed decreased serum cholinesterase, as well as elevated amylase and lipase level. We made the clinical diagnosis of organophosphate poisoning in this patient based on the clinical features, duration of symptoms and signs, and level of serum cholinesterase. Activated charcoal, fluid, and antidotes were administered after gastric lavage. A computerized tomography scan of the abdomen with intravenous contrast showed acute pancreatitis, poor enhancement of the small bowel, pneumatosis cystoides intestinalis, portomesenteric venous gas and ascites. Emergent laparotomy could not be performed because of his poor physical condition and refusal of treatment by his family. The possible mechanisms were believed to be direct intestinal mucosal damage by pancreatic enzymes and secondary mucosal disruption due to bowel ischemia caused by shock and the use of inotropics. Physicians should be warned about the possibility of pneumatosis cystoides intestinalis and portomesenteric venous gas as a complication of pancreatitis following anticholinesterase poisoning.
Full text:
Available
Health context:
Neglected Diseases
Health problem:
Zoonoses
Database:
WPRIM (Western Pacific)
Main subject:
Pancreatitis
/
Physical Examination
/
Pneumatosis Cystoides Intestinalis
/
Poisoning
/
Ascites
/
Respiration
/
Shock
/
Sweat
/
Sweating
/
Thorax
Type of study:
Diagnostic study
Limits:
Aged
/
Humans
Language:
English
Journal:
Journal of The Korean Society of Clinical Toxicology
Year:
2017
Document type:
Article