Trombose mesentérica como complicação da colecistectomia videolaparoscópica

Trombose mesentérica como complicação da colecistectomia videolaparoscópica

Título alternativo Intestinal ischaemia after laparoscopic cholecystectomy
Autor Figueira, Antonio Autor UNIFESP Google Scholar
Apodaca-Torrez, Franz Robert Autor UNIFESP Google Scholar
Colleoni Neto, Ramiro Autor UNIFESP Google Scholar
Triviño, Tarcisio Autor UNIFESP Google Scholar
Instituição Universidade Federal de São Paulo (UNIFESP)
Resumo Intestinal complications after laparoscopic cholecystectomy are rare and usually caused by direct injury sustained on trocar insertion. However, intestinal ischaemia has been reported as an unusual complication of the pneumoperitoneum. We describe a 55-years-old patient who underwent an uneventful laparoscopic cholecystectomy after an episode of acute cholecystitis. Initial recovery was complicated by development of increasing abdominal pain which led to open laparotomy on day 2. Gangrene of the distal ileum and right-sided colon was detected and small bowel resection with right colectomy and primary anastomosis was performed. Histological examination of the resected ileum showed features of venous hemorragic infarction and trombosis. In view of the proximity of the operation it is assumed that ileal ischaemia was precipitated by carbon dioxide pneumoperitoneum. Some studies have been demonstrated that, within 30 minutes of establishing a pneumoperitoneum at an intraabdominal pressure of 16 mmHg, cardiac output, blood flow in the superior mesenteric artery and portal vein decrease progressively. Carbon dioxide pneumoperitoneum may lead to mechanical compression of the splanchnic veins and mesenteric vasoconstriction as a result of carbon dioxide absortion. The distribution of the ischaemic segment of intestine is also unusual as the most precarious blood supply is traditionally at the splenic flexure of the colon. It has been suggested that intermittent decompression of the abdomen reduces the risk of mesenteric ischaemia during penumoperitoneum especially in patients with predisposing clinical features for arteriosclerosis intestinal. In present patient was observed intestinal venous infarction what remains unclear but we think the carbon dioxide pneumoperitoneum have been related to it.
Palavra-chave Laparoscopic
cholecystectomy
Pneumoperitoneum
Artificial
Idioma Português
Data de publicação 1998-08-01
Publicado em Revista do Colégio Brasileiro de Cirurgiões. Colégio Brasileiro de Cirurgiões, v. 25, n. 4, p. 283-284, 1998.
ISSN 0100-6991 (Sherpa/Romeo)
Publicador Colégio Brasileiro de Cirurgiões
Extensão 283-284
Fonte http://dx.doi.org/10.1590/S0100-69911998000400012
Direito de acesso Acesso aberto Open Access
Tipo Artigo
SciELO S0100-69911998000400012 (estatísticas na SciELO)
Endereço permanente http://repositorio.unifesp.br/handle/11600/656

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