Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지
DOI QR코드

DOI QR Code

Pneumatosis Cystoides Intestinales and Portomesenteric Venous Gas following Anticholinesterase Pesticide Poisoning

항콜린에스테라아제 살충제 음독 후 발생한 창자벽공기낭증과 문맥장간막정맥가스 1례

  • Lee, Suk Hee (Department of Emergency Medicine, College of Medicine, Catholic University of Daegu) ;
  • Lee, Kyung-Woo (Department of Emergency Medicine, College of Medicine, Catholic University of Daegu) ;
  • Jung, Jin Hee (Department of Emergency Medicine, School of Medicine, Gyeongsang National University)
  • 이숙희 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • 이경우 (대구가톨릭대학교 의과대학 응급의학교실) ;
  • 정진희 (경상대학교 의과대학 응급의학교실)
  • Received : 2017.05.18
  • Accepted : 2017.06.02
  • Published : 2017.06.30
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Hsiao CT, Yang CC, Deng JF, Bullard MJ, Liaw SJ. Acute pancreatitis following organophosphate intoxication. J Toxicol Clin Toxicol 1996;34:343-7. https://doi.org/10.3109/15563659609013800
  2. Hmouda H, Ben Salem C, Bouraoui K. Management of acute organophosphorus pesticide poisoning. Lancet 2008; 371:2169-70.
  3. Lai WH, Hwang TL, Chen HW. Portomesenteric venous gas in acute bowel ischemia: report of a case. Surg Today 2008;38:656-60. https://doi.org/10.1007/s00595-007-3678-2
  4. Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 2001;177:1319-23. https://doi.org/10.2214/ajr.177.6.1771319
  5. St Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intestinalis. Arch Surg 2003;138:68-75. https://doi.org/10.1001/archsurg.138.1.68
  6. Yoshida S, Okada H, Nakano S, Shirai K, Yuhara T, Kojima H et al. Much caution does no harm! Organophosphate poisoning often causes pancreatitis. J Intensive Care 2015;3:21. https://doi.org/10.1186/s40560-015-0088-1
  7. Chan AC, Poon RT. Portal venous gas and pneumatosis intestinalis in necrotizing pancreatitis. Clin Gastroenterol Hepatol 2014;12:e57-8. https://doi.org/10.1016/j.cgh.2013.10.010
  8. Roeyen G, Chapelle T, Jorens P, de Beeck BO, Ysebaert D. Necrotizing pancreatitis due to poisoning with organophosphate pesticides. Acta Gastroenterol Belg 2008;71:27-9.
  9. Rizos E, Liberopoulos E, Kosta P, Efremidis S, Elisaf M. Carbofuran-induced acute pancreatitis. JOP 2004;5:44-7.
  10. Moritz F, Droy JM, Dutheil G, Melki J, Bonmarchand G, Leroy J. Acute pancreatitis after carbamate insecticide intoxication. Intensive Care Med 1994;20:49-50. https://doi.org/10.1007/BF02425057
  11. Faberman RS, Mayo-Smith WW. Outcome of 17 patients with portal venous gas detected by CT. AJR Am J Roentgenol 1997;169:1535-8. https://doi.org/10.2214/ajr.169.6.9393159
  12. Paran H, Epstein T, Gutman M, Shapiro Feinberg M, Zissin R. Mesenteric and portal vein gas: computerized tomography findings and clinical significance. Dig Surg 2003;20:127-32. https://doi.org/10.1159/000069388
  13. Sebastia C, Quiroga S, Espin E, Boye R, Alvarez-Castells A, Armengol M. Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 2000;20:1213-24. https://doi.org/10.1148/radiographics.20.5.g00se011213
  14. Chai JY, Yun SI, Bae SS, Chae HB, Park SM, Youn SJ et al. A case of jejunal infarction and perforation due to acute pancreatitis. Korean J Gastroenterol. 2004;43:120-4.