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.
Laparoscopic; cholecystectomy; Pneumoperitoneum; Artificial
Laparoscopic; cholecystectomy; Pneumoperitoneum; Artificial
RELATOS DE CASO
Trombose mesentérica como complicação da colecistectomia videolaparoscópica
Intestinal ischaemia after laparoscopic cholecystectomy
Antonio Figueira, ACBC-SPI; Franz Robert Apodaca TorrezII; Ramiro Colleoni Neto, TCBC-SPII; Tarcisio TriviñoIII
IProfessor Adjunto e Livre-Docente da Disciplina de Gastroenterologia Cirúrgica do Departamento de Cirurgia da UNIFESP/EPM
IIAluno de Pós-Graduação da Disciplina de Gastroenterologia Cirúrgica da UNIFESP/EPM
IIIProfessor Adjunto da Disciplina de Gastroenterologia Cirúrgica da UNIFESP/EPM
Endereço para correspondência Endereço para correspondência: Dr. Antonio Figueira Rua Canário 1212/73 04521-005 - São Paulo - SP
ABSTRACT
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.
Key words: Laparoscopic. cholecystectomy; Pneumoperitoneum. Artificial.
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Recebido em 5/11/97
Aceito para publicação em 16/4/98
Trabalho realizado na Disciplina de Gastroenterologia Cirúrgica do Departamento de Cirurgia da Universidade Federal de São Paulo-Escola Paulista de Medicina - UNIFESP/EPM.
- 1. Ishizaki Y, Bandai I, Shimomura K, et al. Changes in splanchinic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide. Surg Endosc 1993;7:420-3.
- 2. Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4.292 hospitals and analysis of 77.604 cases. Am J Surg 1993;165:9-4.
- 3. Paul A, Troidl H, Peters S, et al. Fatal intestinal ischaemia following laparoscopic cholecystectomy. Br J Surg 1994;81:1.207.
- 4. Dwerryhouse SJ, Melsom DS, Burton PA, et al. Acute intestinal ischaemia after laparoscopic cholecystectomy. Br J Surg 1995; 82: 1.413.
- 5. Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 1987;43: 14-20.
Datas de Publicação
-
Publicação nesta coleção
23 Jul 2010 -
Data do Fascículo
Ago 1998
Histórico
-
Aceito
16 Abr 1998 -
Recebido
05 Nov 1997
