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      Portomesenteric Venous System Gas after CT Colonography: A Case Report

      case-report

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          Abstract

          Portomesenteric vein gas can occur owing to a variety of interraleted factors such as loss of mucosal integrity and intraluminal overpressure, and the most common and serious cause is bowel ischemia, which requires urgent laparotomy. Nevertheless, when portal venous gas is caused by nonischemic causes, surgery is not required and it can be treated conservatively. So, its features should be carefully evaluated at CT scan, together with clinical findings. The authors report a case of an old male with portomesenteric venous system gas after CT colonography, without evidence of pneumatosis intestinalis or colonic perforation. A CT scan without enema was required after 24 hours in absence of worsened patient conditions, revealing the disappearance of gas in mesenteric vein and in the portal venous system.

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          Endoscopic perforation of the colon: lessons from a 10-year study.

          M L Anderson, T Pasha, J A Leighton (2000)
          To assess the incidence, clinical features, and management of endoscopic colon perforations in a large number of patients at a major medical teaching center. A retrospective review of medical records of all patients with colon perforations from endoscopy over a 10-yr period. A total of 10,486 colonoscopies were performed over a 10-yr period. There were 20 (0.19%) perforations and two (0.019%) deaths related to colonoscopy and two perforations with no deaths in 49,501 sigmoidoscopies (0.004%). The majority of perforations (65%) occurred in the sigmoid colon. The mean age of the patients was 72 yr (range, 48-87 yr). Multivariate analysis using gender and age showed that female gender was an independent predictor of a higher risk of perforation (p < 0.05). Electrocautery injury (36%) and mechanical injury (32%) from the tip and shaft of the endoscope were the major causes for perforation. Most patients (91%) presented within 48 h of endoscopy. Nine patients (47%) required a surgical resection with primary anastomosis; seven (37%) required a simple closure. The average hospital length of stay was 7.7 +/- 2.8 days. Although trainee endoscopists were involved in only 20% of the colonoscopies performed, eight (40%) perforations occurred while the training fellow was involved in the case. However, this increased risk of perforation with a training fellow was not statistically significant (p = 0.625). Colonoscopy can result in significant morbidity and carries a small risk of death. Sigmoidoscopy has lower risk. The following situations may represent increased risk to colonoscopy patients: unusual difficulty in traversing the sigmoid colon; difficult examinations in female patients, and difficult examinations performed by trainee physicians.
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            Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom.

            David Burling, Mark Taylor, Andrew Slater … (2006)
            To retrospectively determine the incidence of potentially serious adverse events associated with computed tomographic (CT) colonography performed in patients with symptoms of colorectal cancer. Ethical approval and informed consent were waived, since the study was deemed a clinical audit and patients would not be approached. With a national survey in the United Kingdom, all departments offering CT colonography in everyday practice were identified. The lead gastrointestinal radiologist from all responding departments was interviewed, and the frequency of potentially serious adverse events associated with CT colonography performed in patients with symptoms of colorectal cancer, the total number of examinations performed, and technical factors possibly related to perforation were determined. Where a potentially serious adverse event was encountered, it was explored in detail. Responses were collated, and raw frequencies were determined. Fisher exact test was used to determine differences in event rates between groups. At 50 centers, 17 067 CT colonographic examinations (mean number per center, 359; range, 10-3000) were performed. No deaths were reported. Thirteen patients (one [0.08%] of 1313) had had a potentially serious adverse event related to the procedure. There were nine perforations: Four (44%) were asymptomatic and five (56%) were symptomatic, and perforation had an attributable cause, with a symptomatic perforation rate of 0.03% (one in 3413 patients). One patient required laparotomy. An inflated rectal balloon was used to perform 9378 examinations. There was no significant difference between the proportion of perforations associated with rectal balloon inflation (n = 6) and the proportion of those that were not (n = 2) (P = .3). Potentially serious adverse events related to CT colonography occurred in 0.08% of symptomatic patients. (c) RSNA, 2006.
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              Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults.

              Perry Pickhardt (2006)
              Article 0 comments Cited 26 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Radiol
                Journal ID (iso-abbrev): Case Rep Radiol
                Journal ID (publisher-id): CRIM.RADIOLOGY
                Title: Case Reports in Radiology
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6862
                ISSN (Electronic): 2090-6870
                Publication date (Print): 2012
                Publication date (Electronic): 20 September 2012
                Volume: 2012
                Electronic Location Identifier: 420901
                Affiliations
                Complex Operative Unit of Diagnostic Imaging, Campus Bio-Medico University Hospital, Alvaro del Portillo 200, 00128 Rome, Italy
                Author notes
                *Claudia Lucia Piccolo: c.piccolo@ 123456unicampus.it

                Academic Editors: W.-C. Chang and S. Yalcin

                Article
                DOI: 10.1155/2012/420901
                PMC ID: 3461289
                PubMed ID: 23050186
                SO-VID: a54a32ab-4012-43b8-b522-b4f46ba4c037
                Copyright © Copyright © 2012 Ilaria Sansoni et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 July 2012
                Date accepted : 28 August 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging

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