A lucky and reversible cause of 'ischaemic bowel'

Abstract

An 81-year-old man was admitted with an infective exacerbation of chronic obstructive pulmonary disease. He also had clinical and radiological features suggestive of ileus. On day 6 after admission, he developed generalised abdominal pain. Urgent computed tomography of the abdomen showed presence of portovenous gas and dilated small bowel with pneumatosis intestinalis and whirl sign. Emergency laparotomy was performed, which showed a 7-mm perforated ulcer over the first part of the duodenum and small bowel volvulus. Omental patch repair and reduction of small bowel volvulus were performed. No bowel resection was required. The patient had a favourable outcome. Clinicians should suspect small bowel volvulus as a cause of ischaemic bowel. Presence of portovenous gas and pneumatosis intestinalis are normally considered to be signs of frank ischaemic bowel. The absence of bowel ischaemia at laparotomy in this patient shows that this is not necessarily the case and prompt surgical treatment could potentially save the bowels and lives of these patients.

一名81歲男子因其慢性阻塞性肺病有感染加劇的跡象而入院。臨床及影像學亦顯示他同時患有腸梗阻。病人入院後第6天出現腹痛。緊急腹部電腦斷層影像顯示門靜脈積氣，以及小腸擴張併腸壁積氣和漩渦徵。緊急剖腹術發現十二指腸的首部分有直徑7毫米的潰瘍穿孔，並有小腸扭轉。為病人進行大網膜補片修補和減少小腸扭轉，並毋須切除腸臟，病人最後順利康復。臨床醫生如遇上病人有缺血性腸病，應考慮小腸扭轉的病因。門靜脈積氣和腸壁積氣一般被認為是缺血性腸病的病徵。不過，上述患者剖腹時並未發現缺血性腸病，顯示門靜脈和腸壁積氣並不一定代表有缺血性腸病。為患者及時進行手術不但能避免腸切除，更可助挽回生命。