Jorge Catarina, Varela Miguel, Soares Júlio Ricardo, Uribe Hugo, Flores Luis, Moreno Javier
University Hospital Centre of Algarve - Faro Unit, Department of Internal Medicine, Faro, Portugal.
University Hospital Centre of Algarve - Faro Unit, Department of Emergency and Intensive Care, Faro, Portugal.
Clin Pract Cases Emerg Med. 2021 Nov;5(4):473-475. doi: 10.5811/cpcem.2021.5.50803.
A middle-aged woman presented to the emergency department with a chief complaint of abdominal pain, fever, vomiting, and diarrhea. Abdominal computed tomography revealed gastric pneumatosis and air in the portal system. The patient had an unfavorable clinical course with pneumoperitoneum and septic shock due to secondary peritonitis. She underwent emergency laparotomy where neoformation of the mesentery root was found with infiltration of the small intestine and jejunal perforation. The anatomopathological study of the tumor revealed that it was a desmoid tumor.
To our knowledge this is the first report in the literature of gastric pneumatosis as the initial presentation of a mesenteric desmoid tumor. Although it usually has a benign clinical course, its locally invasive characteristics can lead to critical illness. Physicians shouldn't overlook these types of complications, as early identification and surgical intervention can modify the prognosis and shorten hospital stay.
一名中年女性因腹痛、发热、呕吐和腹泻为主诉就诊于急诊科。腹部计算机断层扫描显示胃壁积气和门静脉系统积气。该患者临床过程不佳,因继发性腹膜炎出现气腹和感染性休克。她接受了急诊剖腹手术,术中发现肠系膜根部有新生物,伴有小肠浸润和空肠穿孔。肿瘤的解剖病理学研究显示为硬纤维瘤。
据我们所知,这是文献中首例以胃壁积气作为肠系膜硬纤维瘤首发表现的报告。尽管其临床过程通常为良性,但其局部侵袭性特征可导致危重症。医生不应忽视这类并发症,因为早期识别和手术干预可改善预后并缩短住院时间。