syb 3 general radiology an dang do march 5, 2008
TRANSCRIPT
SYB 3General Radiology
An Dang DoMarch 5, 2008
79 yo WM
POD #8, cystectomy; acute onset of severe abdominal pain;(recently received chemotherapy treatments for urothelial cancer)
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CT Image
CT Image
CT Image
CT Image
Necrotizing Enterocolitis
-one of the more concerning causes of portal venous gas-most common in immunosuppressed patients-necrosis of various layers of bowel walls, almost always cecum (typhlitis)
Contributing factors:mucosal injuryprofound neutropeniaimpaired host defense
Microbes involved:Gram(-) rods; Gram (+) cocci; anaerobes; Candida sp.
Signs and symptoms:ANC < 500/microLfever, abdominal pain/distension, N/V, watery/bloody diarrhea
Song L-M WK, Marcon NE. Necrotizing enterocolitis (typhlitis) in adults. UpToDate. Version 15.3. Accessed March 4, 2008.
Song L-M WK, Marcon NE. Necrotizing enterocolitis (typhlitis) in adults. UpToDate. Version 15.3. Accessed March 4, 2008.
Necrotizing Enterocolitis - Management
Iatrogenic Complication
CXR taken after placement of left subclavian line
Lines and Tubes
Portal venous gas
Free air in abdomen
Distended stomach
CT Image
Although findings of portal venous gas, thickened proximal jejunal wall, pneumatosis and pneumoperitoneal were seen on CT and prompted concerns for necrotizing enterocolitis, two exploratory laparotomy procedures did not show any ischemic bowels or perforation.
Iatrogenic Complication
Left pneumothorax
Lines and Tubes
Mediport
NG tube
ET tube
Keofeed tube
Chest tube
Swan-Ganz catheter