Unità Operativa di Chirurgia Laparoscopica, Dipartimento di Scienze Chirurgiche, Università di Chieti, Via dei Vestini, Chieti 66013, Italy.
Surg Today. 2009;39(10):909-12. doi: 10.1007/s00595-008-3936-y. Epub 2009 Sep 27.
Portal pneumatosis is a rare diagnostic factor, which is often associated with ischemic intestinal accidents. It has been associated with a negative prognosis for a very long time, and the presence of portal pneumatosis is usually an indication for the need to perform a laparotomy. A 68-year-old male patient with diabetes, obstructive lung disease, and a previous cerebral stroke associated with left hemiplegia presented with abdominal pain, fever and neutrophil leukocytosis. Computed tomography (CT) scan showed the presence of portal pneumatosis with signs of acute cholecystitis and remarkable gastrectasia. In consideration of the serious clinical picture, the patient first underwent esophagogastroduodenal endoscopy (EGDS), which showed ulcerative hemorrhagic gastritis. He then underwent a laparoscopic cholecystectomy. The histology results confirmed the intraoperative diagnosis of gangrenous cholecystitis. The patient was discharged on the 7th postoperative day. With the use of new diagnostic techniques, especially CT, the incidence of portal pneumatosis has increased and consequently the clinical approach of surgeons to this pathology is also changing. Indeed, when portal pneumatosis is not associated with intestinal ischemia, the therapeutic approach must be guided by the clinical condition of the patient and by the investigation of the causes of this pathology. The laparoscopic approach can be extremely useful either in the diagnosis (if this has not been achieved by noninvasive means) or in treatment, if possible, of the causes implicated by the portal pneumatosis.
门静脉积气是一种罕见的诊断因素，常与缺血性肠意外有关。很长一段时间以来，它的存在都与预后不良相关，而且门静脉积气的存在通常是需要进行剖腹手术的指征。一位 68 岁的男性患者，患有糖尿病、阻塞性肺病和与左侧偏瘫相关的既往脑卒，表现为腹痛、发热和中性粒细胞白细胞增多。计算机断层扫描（CT）显示存在门静脉积气，伴有急性胆囊炎和显著胃扩张的迹象。考虑到严重的临床情况，患者首先接受了食管胃十二指肠内窥镜检查（EGDS），显示溃疡性出血性胃炎。然后他接受了腹腔镜胆囊切除术。组织学结果证实了术中诊断为坏疽性胆囊炎。患者在术后第 7 天出院。随着新诊断技术的应用，特别是 CT 的应用，门静脉积气的发生率增加了，因此外科医生对这种病理的临床处理方法也在发生变化。事实上，当门静脉积气不伴肠缺血时，治疗方法必须根据患者的临床状况和该病理的病因调查来指导。腹腔镜方法在诊断方面（如果不能通过非侵入性手段实现）或在治疗方面（如果可能的话）都非常有用，可以治疗门静脉积气所涉及的病因。
