Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas, España.
Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas.
Rev Esp Enferm Dig. 2023 Apr;115(4):217-218. doi: 10.17235/reed.2023.9429/2022.
Portal pneumatosis has been considered an ominous sign associated with intestinal ischemia, with a mortality rate of up to 90% as long as it is associated with sepsis. However, the prognosis of mesenteric ischemia depends on the etiology rather than the presence of portal pneumatosis. We present a patient with portal pneumatosis that disappeared 24 hours after the first surgery, but irreversible ischemic lesions were established in the terminal ileum. It should be noted that the excretion of the intravenous contrast is mainly through the kidneys, and it can be eliminated through alternative routes such as the bile duct or the mucosa of the small intestine (vicariant excretion), especially in patients with renal pathology.
门静脉积气曾被认为是与肠缺血相关的凶险征象，只要合并脓毒症，死亡率高达 90%。然而肠系膜缺血的预后取决于病因而非门静脉积气的存在。我们报告了 1 例患者，其在首次手术后 24 小时门静脉积气消失，但末端回肠出现不可逆性缺血性病变。需要注意的是，静脉造影剂的排泄主要通过肾脏，也可以通过胆管或小肠黏膜等替代途径（变异排泄）排出，尤其是在存在肾病理的患者中。
