Brazilian Journal of Anesthesiology
https://www.bjan-sba.org/article/doi/10.1590/S0034-70942009000500011
Brazilian Journal of Anesthesiology
Clinical Information

Síndrome de compartimento abdominal durante pinçamento por via endoscópica de perfuração intestinal secundária à colonoscopia

Abdominal compartment syndrome during endoscopic clamping of an intestinal perforation secondary to colonoscopy

Magda Lourenço Fernandes; Kleber Costa de Castro Pires; Paulo Henrique Baumgratz Chimelli; Márcia Rodrigues Neder Issa

Downloads: 0
Views: 742

Resumo

JUSTIFICATIVA E OBJETIVOS: A colonoscopia é um exame muito utilizado nos dias atuais para diagnóstico, tratamento e controle de doenças intestinais. A perfuração intestinal, embora rara, é a mais temida complicação deste exame. A correção da perfuração pode ser feita através do uso de clipes posicionados por via endoscópica. O objetivo deste relato de caso foi alertar os especialistas para a ocorrência e o tratamento de síndrome de compartimento abdominal durante pinçamento endoscópio de perfuração intestinal secundário à colonoscopia. RELATO DO CASO: Paciente do sexo feminino, 60 anos, estado físico ASA II, submetida à colonoscopia sob sedação. Durante o exame constatou-se perfuração acidental do intestino e optou-se por tentar pinçar a perfuração por via endoscópica. A paciente evoluiu então com dor e distensão abdominal, pneumoperitônio, síndrome de compartimento abdominal, dispnéia e instabilidade cardiovascular. Realizou-se punção abdominal de emergência, o que determinou a melhora clínica da paciente até que laparotomia de urgência fosse realizada. Após laparotomia exploradora e sutura da perfuração a paciente evoluiu clinicamente bem. CONCLUSÕES: O pinçamento por via endoscópica de perfuração intestinal secundária à colonoscopia pode contribuir para a formação de pneumoperitônio hipertensivo e síndrome de compartimento abdominal, com repercussões clínicas graves que exigem tratamento imediato. Profissionais capacitados e recursos técnicos adequados podem ser fatores determinantes do prognóstico do paciente.

Palavras-chave

COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES, EXAMES DIAGNÓSTICOS, SEDAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Colonoscopy is widely used for diagnosis, treatment, and control of intestinal disorders. Intestinal perforation, although rare, is the most feared complication. Perforations can be treated by endoscopic clamping. The objective of this report was to alert specialists for the development and treatment of abdominal compartment syndrome during endoscopic clamping of an intestinal perforation secondary to colonoscopy. CASE REPORT: This is a 60 years old female, physical status ASA II, who underwent colonoscopy under sedation. During the exam, an accidental intestinal perforation was observed, and it was decided to attempt the endoscopic clamping of the perforation. The patient developed abdominal pain and distension, pneumoperitoneum, abdominal compartment syndrome, dyspnea, and cardiovascular instability. Emergency abdominal puncture was done with clinical improvement until urgent laparotomy was performed. After exploratory laparotomy and stitching of the perforation, the patient presented good clinical evolution. CONCLUSIONS: Endoscopic clamping of an intestinal perforation secondary to colonoscopy can contribute for the development of hypertensive pneumoperitoneum and abdominal compartment syndrome with severe clinical repercussions that demand immediate treatment. Capable professionals and adequate technical resources can be determinant of the prognosis of the patient.

Keywords

COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, DIAGNOSTIC TESTS, SEDATION

References

Levin TR, Zhao W, Conell C. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006;145:880-886.

Putcha RV, Burdick JS. Management of iatrogenic perforation. Gastroenterol Clin North Am. 2003;32:1289-1309.

Ball CG, Kirkpatrick AW, Mackenzie S. Tension pneumothorax secondary to colonic perforation during diagnostic colonoscopy: report of a case. Surg Today. 2006;36:478-480.

Garcia Martínez MT, Ruano Poblador A, Galan Raposo L. Perforation after colonoscopy: our 16-year experience. Rev Esp Enferm Dig. 2007;99:588-592.

Rabeneck L, Paszat LF, Hilsden RJ. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135:1899-1906.

Yokobi-Shvili R, Cheng D. Tension pneumoperitoneum: A complication of colonoscopy: recognition and treatment in the emergency department. J Emerg Med. 2002;22:419-420.

Ivatury RR, Diebel L, Porter JM. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am. 1997;77:783-800.

Peppriell JE, Bacon DR. Acute abdominal compartment syndrome with pulseless electrical activity during colonoscopy with conscious sedation. J Clin Anesth. 2000;12:216-219.

Schein M, Wittmann DH, Aprahamian CC. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg. 1995;180:745-753.

Ignjatoviæ M, Joviæ J. Tension pneumothorax, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopic polypectomy: a case report and review of the literature. Langenbecks Arch Surg. 2009;394:185-189.

Carr-Locke DL. The changing management of colonoscopyassociated. Digestion. 2008;78:216-217.

Magdeburg R, Collet P, Post S. Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc. 2008;22:1500-1504.

Resolução nº 1886, de 13 de novembro de 2008: Dispõe sobre as Normas mínimas para o funcionamento de consultórios médicos e dos complexos cirúrgicos para procedimentos com internação de curta permanência. Diário Oficial da União. 21 n:271-273.

5dd675770e88250715c8fca6 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections