Pneumatosis intestinalis and hepatic portal venous gas after CPR.
Pneumatosis intestinalis and hepatic portal venous gas are usually associated with severe intra-abdominal pathologies. As diagnostic technologies advanced, a number of variant etiologies have been identified. We report 2 cases in which pneumatosis intestinalis and hepatic portal venous gas developed after prolonged cardiopulmonary resuscitation (CPR). The pathogenic mechanism was most probably bowel infarction caused by poor mesenteric perfusion during and after CPR. Limited cardiac output during prolonged resuscitation and severe vasoconstriction after large doses of epinephrine and vasopressors might both contribute to the compromised mesenteric perfusion. The risk seems especially high for old patients with severe atherosclerosis. Once it happens, the prognosis is extremely poor. In patients of cardiac arrests receiving prolonged CPR, catastrophic complications like this should be considered in the postresuscitation phase, especially those with multiple risk factors like old age, severe atherosclerosis, and use of large doses of vasoconstrictors.
Lai
Chun-Fu
CF
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chang
Wei-Tien
WT
Liang
Po-Chin
PC
Lien
Wan-Ching
WC
Wang
Hsiu-Po
HP
Chen
Wen-Jone
WJ
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D004554:Electric Countershock; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology; D004635:Emergency Medicine / Q000379:methods*; D017809:Fatal Outcome; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000175:diagnosis* / Q000209:etiology*; D011169:Portal Vein; D012769:Shock / Q000150:complications / Q000628:therapy; D014693:Ventricular Fibrillation / Q000209:etiology / Q000628:therapy