Comes to our attention a 82 years old male,
with complex medical history and poor physical condition,
ileal anastomosis recently worked for and with previous cholecystectomy and pancreatic resection for hemorrhagic-necrotic pancreatitis.
Abdominal pain,
primarily epigastric,
as well as the recent emergence of vomiting.
Presence of massive sub-umbilical hernia,
abdominal fairly treatable,
without signs of peritoneal irritation.
Physical examination: MV spread,
reduced to the basics.
Fig. 2: Fig. 1-2) Direct examination of the abdomen performed in supine position, antero-posterior (a) and lateral projection (b): overdistension of some jejunal loops, air fluid levels.
Fig. 1: Fig. 1-2) Direct examination of the abdomen performed in supine position, antero-posterior (a) and lateral projection (b): overdistension of some jejunal loops, air fluid levels.
In the ward are given orally 50 ml of diluted 50% Gastrografin,
with a serious deterioration of already poor clinical condition,
for emergence of severe dyspnea.
Fig. 3: Fig. 3-4) Chest radiographs performed in antero-posterior projection alone, before (a) and after (b) the administration of Gastrografin, resulting in severe respiratory activity worsening. In (a) notes the substantial negative findings (outcomes fracture rib on the right). In (b) also show the appearance extensive lung parenchimal opacity are, including the district bilateral perihilar and basal; the cardiac silhouette is not enlarged.
Fig. 4: Fig. 3-4) Chest radiographs performed in antero-posterior projection alone, before (a) and after (b) the administration of Gastrografin, resulting in severe respiratory activity worsening. In (a) notes the substantial negative findings (outcomes fracture rib on the right). In (b) also show the appearance extensive lung parenchimal opacity are, including the district bilateral perihilar and basal; the cardiac silhouette is not enlarged.
Is performed in emergency CT scans of the torax,
which evidence extensive alteration of lung density in relation "ground glass",
as well as by large areas of consolidation,
mainly the middle and lower fields,
bilaterally.
In some locations primarily,
in portions declivities,
give attenuation values are comparable to those of gastric contents,
for the presence of hyperdense Gastrografin.
A segmental bronchus in the lower lobe,
is occupied by hyperdense content.
This condition is given by consequent inhalation of hyperosmolar contrast medium.
Fig. 5: Fig. 5-7) See text.
Fig. 6: Fig. 5-7) See text.
Fig. 7: Fig. 5-7) See text.
Is given appropriate therapy,
but after an initial improvement of clinical conditions,
the poor general condition of the patient lead exitus.