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Resumen Una mujer de 82 años con antecedentes de hiperten sión arterial e hipotiroidismo acudió al servicio de urgencias por dolor abdominal, diarrea, confusión y deterioro de su estado general de varios días de evolu ción. A su admisión, la paciente se encontraba febril y la analítica mostró una elevación de la proteína C reac tiva sin leucocitosis (8.9 × 10[PRESERVECIRC]9/L). En ese contexto se realizó exudado nasofaríngeo para SARS-CoV-2 que fue negativo. Con estos resultados, la sospecha inicial era la de un cuadro infeccioso de origen digestivo. La muestra de orina era maloliente con presencia de leucocitos y nitritos enviándose a cultivo microbiológico. Se inició tratamiento antibiótico empírico con una cefalosporina de tercera generación ante la sospecha de une posible infección urinaria. Se decidió la realización de una tomografía tóraco-abdomino-pélvica con el objetivo de evaluar la presencia de otros focos infecciosos en una paciente de edad avanzada. Este estudio mostró una cistitis enfisematosa, una enfermedad poco fre cuente en una paciente sin ninguno de los factores de riesgo clásicos para esta entidad. Los cultivos de orina y sangre fueron positivos para Escherichia coli sensible al antibiótico empírico por lo que se continuó para completar 7 días de tratamiento. La evolución clínica fue favorable.
Abstract An 82-year-old woman with a previous medical his tory of hypertension and hypothyroidism was admitted to the emergency department for abdominal pain, dia rrhea, confusion and changes in her overall condition over several days. At the emergency department, the patient was febrile and her blood tests showed elevated C-reactive protein without leukocytosis (8.9 × 10[PRESERVECIRC]9/L). In the current context, a nasopharyngeal swab for SARS was performed and was negative. With these results, the initial suspicion was that of an infectious condi tion of gastrointestinal origin. The urine sample was foul-smelling with presence of leukocytes and nitrites and was sent out for culture. In the setting of probable urinary tract infection, empirical antibiotic treatment was started with a third generation cephalosporin. It was decided to perform a total body scanner in order to evaluate the presence of other infectious foci. The study described the presence of emphysematous cystitis, a rare pathology in a patient without any of the classic risk factors for this entity. Urine and blood cultures were positive for Escherichia coli sensitive to the empiric antibiotic which was continued to complete 7 days. The clinical course was favorable.
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An 82-year-old woman with a previous medical history of hypertension and hypothyroidism was admitted to the emergency department for abdominal pain, diarrhea, confusion and changes in her overall condition over several days. At the emergency department, the patient was febrile and her blood tests showed elevated C-reactive protein without leukocytosis (8.9 × 10^9/L). In the current context, a nasopharyngeal swab for SARS was performed and was negative. With these results, the initial suspicion was that of an infectious condition of gastrointestinal origin. The urine sample was oul-smelling with presence of leukocytes and nitrites and was sent out for culture. In the setting of probable urinary tract infection, empirical antibiotic treatment was started with a third generation cephalosporin. It was decided to perform a total body scanner in order to evaluate the presence of other infectious foci. The study described the presence of emphysematous cystitis, a rare pathology in a patient without any of the classic risk factors for this entity. Urine and blood cultures were positive for Escherichia coli sensitive to the empiric antibiotic which was continued to complete 7 days. The clinical course was favorable.
Una mujer de 82 años con antecedentes de hipertensión arterial e hipotiroidismo acudió al servicio de urgencias por dolor abdominal, diarrea, confusión y deterioro de su estado general de varios días de evolución. A su admisión, la paciente se encontraba febril y la analítica mostró una elevación de la proteína C reactiva sin leucocitosis (8.9 × 10
Assuntos
Cistite , Enfisema , Infecções Urinárias , Humanos , Feminino , Idoso de 80 Anos ou mais , Enfisema/complicações , Enfisema/terapia , Tomografia Computadorizada por Raios X , Cistite/complicações , Cistite/diagnóstico , Cistite/tratamento farmacológico , Antibacterianos/uso terapêutico , Dor Abdominal/complicações , Escherichia coliRESUMO
Background: Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and surrounding tissues that results in gas formation in the kidney, collecting system, or surroundings. EPN is a rare condition in veterinary medicine and occurs most frequently in dogs with diabetes mellitus. Although the prognosis of medical management in animals is poor, the standardized treatment protocol according to EPN severity is unclear. This report describes the first case of a nondiabetic female cat with extensive EPN and good prognosis following direct nephroureterectomy (NU). Case: A 10-year-old spayed female cat presented with the chief complaint of an acute loss of weight within 1 week, vomiting, and disorientation including stumbling, discoordination, circling, wobbling, head tilting, and difficulties in standing. At presentation, the patient had a body condition score of 1/9 and weighed 2.6 kg. Blood examination revealed leukocytosis, anemia, and hypoproteinemia. Abdominal radiography revealed severely decreased serosal details. A massive gas silhouette observed in the peritoneal and retroperitoneal cavities, was diagnosed as abdominal free gas. Abdominal ultrasound showed an accumulation of moderately anechoic fluid mixed with gas and cyst-like capsules around the left kidney. Left partial ureteral obstruction and dilation were also observed. Computed tomography (CT) was performed without sedatives or anesthetic drugs. The findings showed severe inflammatory changes in the peritoneum and a loss of the normal inner structure in the left kidney. A pyelogram of the left kidney was not observed after injection of the contrast material. Diffuse fat stranding and free gas observed in the mesentery of the entire abdominal cavity and around the left kidney were considered septic peritonitis. Urinalysis revealed proteinuria and hematuria. Numerous neutrophils with rod-type bacteria were observed in the ascites. Following diagnostic examinations, the patient was diagnosed with extensive left EPN, including inflammatory ascites and abdominal free gas. Therefore, emergency NU of the nonfunctional left kidney and ruptured ureter and thorough abdominal lavage were conducted. Diffuse inflammation and a nephrolith were observed in the section of the harvested kidney. The nephrolith was composed of 100% calcium oxalate monohydrate. The realtime polymerase chain reaction (RT-PCR) test for feline infectious peritonitis (FIP) was negative. Escherichia coli was detected in the ascites, and antibiotic therapy was administered following the antibiotic sensitivity test. The histological findings from the left kidney and ureter included marked chronic inflammation and fibrosis. The patient was discharged 4 days after surgery. During the 8-month follow-up period, the patient's condition improved. Discussion: This was a unique case of EPN in a nondiabetic cat and the first reported case of EPN with a ruptured ureter, including abdominal free gas, inflammatory ascites, and peritonitis. This patient had a bacterial urinary tract infection with E. coli, which is the most frequently isolated pathogen in humans. This gas-forming bacteria produced a massive amount of gas and inflammation that were considered to have ruptured the urinary tract, so that the gas was released into the abdomen. This case corresponded to class 3B, with two risk factors according to the human EPN classification system. Direct NU and abdominal lavage were performed as emergency surgeries. The patient stabilized gradually and showed a good prognosis. Immediate surgical intervention is recommended in animal patients showing the extensive EPN stage.
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Animais , Feminino , Gatos , Peritonite/veterinária , Pielonefrite/cirurgia , Pielonefrite/veterinária , Escherichia coli/isolamento & purificação , Nefroureterectomia/veterináriaRESUMO
Emphysematous pyelonephritis (EPN) is a severe disease of the renal system in which gas formed by facultative anaerobe microorganisms accumulates, being Escherichia coli the most representative causative agent. A series of conditions foster its development including uncontrolled diabetes mellitus, diabetic nephropathy and obstructive uropathy. Abdominal CT scan continues to be the gold standard for diagnosis. Currently, nephrectomy is avoided as much as possible, and more conservative treatments are given. Mortality is still as high as 21 % despite new therapeutic options, all of which are mostly surgical. The rarest cases are those classified as grade IV, which affect both kidneys; these are considered the most lethal of the clinical presentations and they are also of particular interest, since a multidisciplinary team must be in charge of treatment. Herein, we present the case of an elderly woman with chronic diseases and a presentation of massive emphysematous pyelonephritis concurrent with emphysematous cystitis and pneumoperitoneum, who required bilateral radical nephrectomy despite efforts of preserving at least one of the kidneys.
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BACKGROUND: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and surrounding tissues with significant mortality. We aimed to assess the clinical factors and their influence on prognosis in patients being managed for EPN with and without ESBL-producing bacteria and to identify if those with EPN due to ESBL infections fared any different. METHODS: A retrospective analysis was performed on patients with EPN diagnosis from 22 centers across 11 countries (between 2013 and 2020). Demographics, clinical presentation, biochemical parameters, radiological features, microbiological characteristics, and therapeutic management were assessed. Univariable and multivariable analyses were performed to determine the independent variables associated with ESBL pathogens. A comparison of ESBL and non-ESBL mortality was performed evaluating treatment modality. RESULTS: A total of 570 patients were included. Median (IQR) age was 57 (47-65) years. Among urine cultures, the most common isolated pathogen was Escherichia coli (62.2%). ESBL-producing agents were present in 291/556 urine cultures (52.3%). In multivariable analysis, thrombocytopenia (OR 1.616 95% CI 1.081-2.413, p = 0.019), and Huang-Tseng type 4 (OR 1.948 95% CI 1.005-3.778, p= 0.048) were independent predictors of ESBL pathogens. Patients with Huang-Tseng Scale type 1 had 55% less chance of having ESBL-producing pathogens (OR 1.616 95% CI 1.081-2.413, p = 0.019). Early nephrectomy (OR 2.3, p = 0.029) and delayed nephrectomy (OR 2.4, p = 0.015) were associated with increased mortality in patients with ESBL infections. Conservative/minimally invasive management reported an inverse association with mortality (OR 0.314, p = 0.001). CONCLUSIONS: ESBL bacteria in EPN were not significantly associated with mortality in EPN. However, ESBL infections were associated with poor prognosis when patients underwent nephrectomy compared conservative/minimally invasive management.
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Acute massive gastric dilatation is a rare condition mainly seen in patients with alimentary disorders. This massive distention may cause gastric necrosis and even perforation and emphysematous gastritis. We report the case of an 18-year-old female with intense abdominal pain and signs of sepsis. Computed-tomography scan diagnosed an acute massive gastric distention within gas into the gastric wall. Despite rapid instauration of conservative treatment, the patient finally underwent surgery. It is important to discard this infrequent pathology even in young and healthy people. An early diagnosis is crucial, a rapid instauration of conservative management may be effective and avoid surgery.
La distensión gástrica masiva es una condición rara, principalmente descrita en pacientes con trastornos de la conducta alimentaria, que puede evolucionar hacia una necrosis, perforación o gastritis enfisematosa. Reportamos el caso de una paciente de 18 años valorada por intenso dolor abdominal y sepsis, diagnosticada de distensión gástrica masiva. A pesar del tratamiento conservador, la paciente requirió cirugía urgente. Es importante descartar esta entidad cuando valoramos a un paciente en Urgencias ya que es una patología infrecuente presente en gente joven y sana. Un diagnóstico temprano es crucial porque el tratamiento conservador precoz puede ser eficaz y evitar la cirugía.
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Gastrite , Adolescente , Humanos , Nível de Saúde , Gastrite/diagnóstico , FemininoRESUMO
BACKGROUND: Diagnosis of emphysematous pyelonephritis has been described around the world for some decades, frequently associated with Escherichia coli and other anaerobic, gas-forming bacteria and mostly in patients living with diabetes. We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis. CASE SUMMARY: A 38-year-old female presented with fever, severe pain in the right flank and changes in urinary habits. She was admitted, and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures; the latter showed Serratia fonticola as a single pathogen. After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile, and the gas presence reduced. CONCLUSION: Emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening. This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.
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Objective: To describe the microbiological characteristics in emphysematous pyelonephritis (EPN), demonstrate the frequency of extended-spectrum beta-lactamase (ESBL) microorganisms, and determine if these microorganisms are associated with the prognosis of patients with EPN. Methods: We conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016. Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms. Statistical significance was set with p<0.05. Results: A total of 63 patients were included; 55 (87.3%) of them were females, with a median age of 55 (interquartile range: 45-65) years. Conservative management was indicated in 38.1%; 42.9% were treated with ureteral stent; 12.7% with open or percutaneous drainage; 15.8% with early nephrectomy; and 9.5% with delayed nephrectomy. Reported mortality was 13 (20.6%) cases; 23 (36.5%) cases required admission to the intensive care unit. The most frequent microorganism isolated was Escherichia coli (n=34, 53.9%). ESBL microorganisms were found in 31.7% of the population. No significant association of ESBL was found with admission to the intensive care unit, or with increased mortality. Conclusions: To our knowledge, this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN. Risk factors associated with a poor prognosis in patients with EPN have been described. The microbiological factors, specifically ESBL-producing bacteria, do not seem to influence in the prognosis of these patients.
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INTRODUCTION AND OBJECTIVES: Emphysematous pyelonephritis is a life-threatening infection of the kidney and surrounding tissues associated with a high mortality rate. The aim of this study was to determine predictive factors for mortality and intensive care unit admission in patients with emphysematous pyelonephritis, and to propose a therapeutic algorithm based on current literature and our experience. METHODS: A retrospective study was done including patients with emphysematous pyelonephritis in a single center in the north of Mexico from 2011 to 2016. Demographic, clinical, microbiological and biochemical parameters, therapeutic management, and outcomes were assessed. Factors associated with admission to intensive care unit and mortality were determined. Comparison was assessed using X2 test for categorical variables, and T-test for numerical variables. Univariate and multivariate logistic regression analyses were performed. Statistical significance was set at Pâ¯<â¯.05. RESULTS: A total of 63 patients were included, of which 55 (87.3%) were females, with a mean age of 55.5⯱â¯12.2 years. The most common comorbidities were diabetes and hypertension. Escherichia coli was the most common isolated microorganism (51.7%) and extended-spectrum beta-lactamase-producing agents were reported in 31.7%. Conservative therapy was provided to 38.7%, double J stent 42.9%, open/percutaneous drainage 12.7%, and nephrectomy 25.3%. Overall mortality and intensive care admission were 20.6% and 36.5%, respectively. In the multivariate analysis, hemodynamic instability (Pâ¯=â¯.005), qSOFAâ¯≥â¯2 (Pâ¯=â¯.003), hypoalbuminemia (Pâ¯=â¯.02), and early nephrectomy (Pâ¯=â¯.002) were associated with intensive care admission. Huang scale 4 (Pâ¯=â¯.006) and early nephrectomy (Pâ¯=â¯.001) were associated to mortality. CONCLUSIONS: Emphysematous pyelonephritis is a life-threatening disease and evidence of management is based in small case series due to the low incidence of this condition. Hemodynamic instability, hypoalbuminemia, qSOFAâ¯≥â¯2, Huang scale ≥3, and early nephrectomy are associated with poor prognosis.
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Enfisema , Hipoalbuminemia , Pielonefrite , Adulto , Idoso , Enfisema/epidemiologia , Enfisema/etiologia , Enfisema/terapia , Feminino , Humanos , Hipoalbuminemia/complicações , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pielonefrite/epidemiologia , Pielonefrite/terapia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
INTRODUCTION: Hundreds of thousands of cholecystectomies and appendectomies are performed in the United States annually. Due to the prevalence of cholecystitis and appendicitis, a subset of patients will require both operations. The limited literature describing these patients supports a laparoscopic approach over open surgery; consistent with the advantages of laparotomy over open surgery in the treatment of each condition individually. CASE PRESENTATION: We report two cases where a patient presented with cholecystitis and appendicitis simultaneously. An abdominal computer tomography (CT) scan revealed the presence of the two diagnoses, which was then confirmed by an abdominal ultrasound. A four-access port was utilized for simultaneous appendectomy and cholecystectomy. DISCUSSION: A review of the literature indicates that simultaneous infection with appendicitis and cholecystitis is rare, and thus clinical presentation, lab work, and imaging studies are all needed to support such a diagnosis. Potential findings on imaging in these patients may include distended gallbladder with thickened wall and fluid-filled dilated appendix with mural enhancement. In the event that both clinical presentation and further work-up indicate both pathologies, laparoscopic intervention is suitable. A four-access port is deemed the conservative approach to dealing with such cases. CONCLUSION: Finding a single diagnosis responsible for a patient's illness is a high priority in an acute care setting, a concept known as diagnostic parsimony. However, it is inevitable that very common illnesses will be comorbid in a subset of patients, and physicians should be prepared to consider contemporaneous illness in the isolated circumstances it is warranted.
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Resumen Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.
Abstract Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.
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Resumen A través del presente reporte se describe un caso de gastritis enfisematosa, una rara condición clínica consistente en la invasión de la pared gástrica por microorganismos productores de gas. Puede resultar en una situación fatal debido a lo inespecífico de su clínica y a lo tórpido de su evolución. En este caso se describe a un paciente anciano de 77 años, con alta fragilidad, quien cursaba con un cuadro de gastritis enfisematosa que no respondió a manejo médico y requirió gastrectomía de urgencia. Adicionalmente, cursaba con un adenocarcinoma gástrico ulcerado infiltrante, que previamente no había sido diagnosticado, como probable factor condicionante y desencadenante.
Abstract This report describes a case of emphysematous gastritis, a rare clinical condition consisting of invasion of the gastric wall caused by gas-producing bacteria. It can lead to fatal outcomes due to the unspecific nature of the symptoms and its torpid course. The following is the case of a highly fragile 77-year-old male patient, who presented with symptoms of emphysematous gastritis that did not respond to medical treatment and required emergency gastrectomy. In addition, the patient had an infiltrating ulcerated gastric adenocarcinoma, which had not previously been diagnosed and was a probable conditioning and triggering factor.
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Humanos , Masculino , Idoso , Adenocarcinoma , Gastrite , EmergênciasRESUMO
La pielonefritis enfisematosa es una enfermedad poco frecuente. Esta consiste en una infección necrotizante severa del parénquima renal asociada a formación de gas en el sistema colector, parénquima renal y/o tejidos perirrenales. Se presenta una paciente de 54 años de edad con antecedentes de diabetes mellitus tipo 2 no controlada y litiasis urinaria, atendida en el Cuerpo de Guardia del Hospital Celia Sánchez Manduley, Granma, Cuba. Presentaba náuseas y vómitos, dolor en ambos lados de la región lumbar, y fiebre. La ecografía mostró riñones hiperecogénicos e imágenes ecorefringentes en proyección de las cavidades renales. El cultivo de orina probó la presencia de escherichia coli, y se medicó de forma endovenosa. Por evolución no favorable, se realizó tomografía que evidenció patrón gaseoso en cavidades renales. Se reajustó la antibioticoterapia parenteral y la evolución fue favorable. Se dio alta de consulta, luego de 10 meses de seguimiento asintomática, con diagnóstico de pielonefritis enfisematosa(AU)
Emphysematous pyelonephritis is a rare disease, consisting of severe necrotizing infection of the renal parenchyma associated with gas formation in the collecting system, renal parenchyma and / or peri renal tissues. We report a 54-year-old patient with history of uncontrolled type 2 diabetes mellitus and urinary stones, she was treated in the emergency service at Celia Sánchez Manduley Hospital, Granma, Cuba. She had nausea and vomiting, pain on both sides of her lower back, and fever. Ultrasound showed hyper-echogenic kidneys and echo-refractive images in projection of the renal cavities. The urine culture proved the presence of Escherichia coli, and medications was administered intravenously. Due to the unfavorable evolution, a tomography was performed and it showed a gas pattern in the renal cavities. Parenteral antibiotic therapy was readjusted and the outcome was favorable. After 10 months of asymptomatic follow-up, she was discharged from the clinic with diagnosis of emphysematous pyelonephritis(AU)
Assuntos
Humanos , Feminino , Pielonefrite/epidemiologia , Ultrassonografia/métodos , Diabetes Mellitus Tipo 2/epidemiologia , Nefrolitíase/diagnóstico por imagemRESUMO
Major interventions in cardiovascular surgery of patients with aortic pathology can result in the compromise of perfusion of organs distant from the surgery site, the gastrointestinal tract being one of the most sensitive to hemodynamic changes, especially in extreme age groups with a high risk of morbidity and mortality. The case of a young infant is reported, with a history of Turner syndrome, who is led to correction of aortic coarctation plus arch hypoplasia, presenting as a postoperative complication a picture of emphysematous gastritis with systemic compromise, a process that was favored by low cardiac output post-pump and the presence of early urosepsis, all of which was interpreted as part of the spectrum of non-occlusive mesenteric ischemia syndrome. Its early diagnosis made possible a prompt intervention consisting of parenteral nutritional support, acid brake, broad-spectrum antibiotic therapy and strict radiological follow-up, achieving complete resolution of her symptoms, without short-term complications. This case demonstrated that the identification of risk factors for splanchnic ischemia, a high clinical suspicion and careful medical management, allowed a favorable outcome for a disease with a high mortality rate and very few cases reported in the pediatric population.
Las intervenciones mayores en cirugía cardiovascular de pacientes con patología aórtica pueden traer como consecuencia el compromiso de la perfusión de órganos distantes al sitio de la cirugía, siendo el tracto gastrointestinal uno de los más sensibles a los cambios hemodinámicos, en especial en grupos extremos de edad con un alto riesgo de morbimortalidad. Se reporta el caso de una lactante con antecedente de síndrome de Turner, quien es llevada a corrección de coartación de aorta más hipoplasia del arco, presentando como complicación posoperatoria un cuadro de gastritis enfisematosa con compromiso sistémico, proceso que fue favorecido por bajo gasto cardiaco posterior a bomba y presencia de urosepsis temprana, todo lo cual fue interpretado como parte del espectro del síndrome de isquemia mesentérica no oclusiva. Su diagnóstico precoz hizo posible una pronta intervención, consistente en soporte nutricional parenteral, freno ácido, antibioticoterapia de amplio espectro y seguimiento radiológico estricto, logrando la resolución completa de su sintomatología, sin complicaciones a corto plazo. Este caso demuestra que la identificación de factores de riesgo de isquemia esplácnica, una alta sospecha clínica y un cuidadoso manejo médico permiten un desenlace favorable para una patología con una alta tasa de mortalidad y muy pocos casos reportados en población pediátrica.
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Background: Malignant edema is one of the terms used to designate severe necrotizing syndromes in soft tissues by Clostridium spp. which are potentially fatal in farm animals. These species are responsible for myonecrosis, belonging to the group of histotoxic clostridia, and may also culminate in toxemia with the worsening of the lesions. These clostridia and their spores require a gateway such as wounds on mucous membranes or skin, which may occur due to shear, tail cut, injuries during delivery, castration or injections by contaminated needles. This report aims to describe the clinicalpathological findings of a case of malignant edema caused by Clostridium perfringens type A in an equine. Case: A female equine, undefined breed, used as traction animal, had a history of abdominal pain. According to the requisitioning veterinary, the tutor reused needles for medication. On palpation, a compact mass was noticed in the pelvic f lexure, as well as edema on the region of head and neck with crackling areas. After surgical intervention for compactation correction, the animal did not show anesthetic recovery and was submited to euthanasia. Tissue samples were collected, f ixed in 10% buffered formalin solution, routinely processed for histopathology and stained with hematoxylin and eosin and Gram stain. Samples of serous-sanguineous edema fluid and fragments of the abdominal muscles and neck were collected. The samples were kept under refrigeration and sent for microbiological culture. Necropsy showed the subcutaneous region of the pectoral was markedly gelatinous and yellowish (edema) and subcutaneous emphysema characterized by accumulation of serous-sanguineous fluid and gas bubbles. In microscopy, we verified fibrous-haemorrhagic...(AU)
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Animais , Feminino , Clostridium perfringens/isolamento & purificação , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/veterinária , Cavalos/microbiologia , Edema/veterinária , Reação em Cadeia da Polimerase/veterinária , Enfisema Pulmonar/veterináriaRESUMO
Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.
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Cistite/complicações , Complicações do Diabetes/microbiologia , Enfisema/diagnóstico por imagem , Pielonefrite/complicações , Choque Séptico/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Tratamento Conservador , Cistite/diagnóstico , Cistite/tratamento farmacológico , Cistite/microbiologia , Complicações do Diabetes/patologia , Enfisema/etiologia , Escherichia coli/isolamento & purificação , Feminino , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Vômito/diagnóstico , Vômito/etiologiaRESUMO
Antecedentes: la colecistitis enfisematosa (CE) es una forma de presentación infrecuente de la colecistitis aguda. Material y métodos: presentecedentes patológicos, mientras que los otros eran diabéticos. A todos se les realizó tomografía computarizada (TC). Dos pacientes fueron sometidos a colecistectomía videolaparoscópica (CL) con buena evolución, mientras que en un caso se realizó colecistostomía percutánea (CP). Discusión: la CE se refiere a la presencia de gas en la luz o en la pared de la vesícula biliar. La tasa de morbilidad es del 50%. Los pacientes suelen padecer diabetes, pero puede presentarse en pacientes más jóvenes sin factores de riesgo. La TC es el método de elección para el diagnóstico. El tratamiento definitivo es la CL, aunque la CP es otra opción válida. Conclusión: la CL se considera un enfoque eficaz y seguro para el tratamiento de la CE.
Background: Emphysematous cholecystitis (EC) is a rare presentation of acute cholecystitis. Material and methods: We report three cases of EC in two men and one woman between 55 and 79 years. One of the patients was otherwise healthy while the other two were diabetics. A computed tomography (CT) scan was performed in all the cases. Two patients underwent video-assisted laparoscopic cholecystectomy with favorable outcome and one patient underwent percutaneous cholecystostomy. Discussion: Emphysematous cholecystitis is characterized by the presence of gas in the gallbladder lumen or wall. Mortality rate is 50%. Most patients are diabetics, but EC may present in younger patients without risk factors. Computed tomography scan is the method of choice for the diagnosis. Cholecystectomy is indicated as definite treatment, but percutaneous cholecystostomy may be a valid option. Conclusions: Laparoscopic cholecystectomy and antibiotics are effective and safe to treat.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Colecistectomia Laparoscópica/métodos , Colecistite Enfisematosa/cirurgia , Colecistostomia/métodos , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/complicações , Colecistite Enfisematosa/tratamento farmacológico , Colecistite Enfisematosa/diagnóstico por imagem , Complicações do Diabetes , Abdome/diagnóstico por imagem , Hipertensão/complicaçõesRESUMO
Background: Malignant edema is one of the terms used to designate severe necrotizing syndromes in soft tissues by Clostridium spp. which are potentially fatal in farm animals. These species are responsible for myonecrosis, belonging to the group of histotoxic clostridia, and may also culminate in toxemia with the worsening of the lesions. These clostridia and their spores require a gateway such as wounds on mucous membranes or skin, which may occur due to shear, tail cut, injuries during delivery, castration or injections by contaminated needles. This report aims to describe the clinicalpathological findings of a case of malignant edema caused by Clostridium perfringens type A in an equine. Case: A female equine, undefined breed, used as traction animal, had a history of abdominal pain. According to the requisitioning veterinary, the tutor reused needles for medication. On palpation, a compact mass was noticed in the pelvic f lexure, as well as edema on the region of head and neck with crackling areas. After surgical intervention for compactation correction, the animal did not show anesthetic recovery and was submited to euthanasia. Tissue samples were collected, f ixed in 10% buffered formalin solution, routinely processed for histopathology and stained with hematoxylin and eosin and Gram stain. Samples of serous-sanguineous edema fluid and fragments of the abdominal muscles and neck were collected. The samples were kept under refrigeration and sent for microbiological culture. Necropsy showed the subcutaneous region of the pectoral was markedly gelatinous and yellowish (edema) and subcutaneous emphysema characterized by accumulation of serous-sanguineous fluid and gas bubbles. In microscopy, we verified fibrous-haemorrhagic...