Ristilloftblöðrur : sjúkratilfelli á fæðingardeild Fjórðungssjúkrahússins á Akureyri

Abstract

A 36 year old woman, pregnant 41 weeks and two days was admitted to the hospital in labour. The course was slow, foetal distress was seen with foetal heart monitoring. Cesarean section was performed and a healthy boy delivered. Three days later she developed abdominal pain and passed extensive flatus. Fever was 39°C rectally. Abdominal x-ray showed signs of mechanical ileus and laparotomy was performed. Appendix was swollen and therefore removed. Post operatively the woman developed massive diarrhea. Acute colonoscopy showed air-filled vesicles in distal colon, macroscopically diagnosed as pneumatosis coli. The treatment was 50% oxygen initially but was increased to 70% because of slow improvement. P02 was kept at 250-300 Hg and colonoscopy on the 24th day showed almost full recovery. Discussion: Pneumatosis cystoides intestinalis is a rare, benign disease, characterized by subserosal/ submucosal vesicles, varying in size and number. Aetiology is unknown but it has been associated with some gastrointestinal diseases, abdominal surgery, and lung diseases. The pathology is unknown but three main theories exist. Symptoms can be abdominal pain, diarrhea, flatus and rectal bleeding. Diagnosis is by x-ray, CT scan or colonoscopy. Treatment is high oxygen doses for one to two weeks but if another disease is underlying surgery might be needed. The prognosis is good but a certain chance of relapse exists.

Þrjátíu og sex ára gömul kona, gengin rúmlega 41 viku kom á fæðingardeild Fjórðungssjúkrahússins á Akureyri með hríðarverki. Fæðing gekk hægt og þurfti að framkvæma keisaraskurð. Þremur dögum síðar fékk konan kviðverki og mikinn vindgang. Hiti mældist 39°C. Röntgenmynd af kvið vakti grun um garnastíflu og var því gerður kviðarholsskurður og bólginn botnlangi fjarlægður. Eftir það hafði konan mikinn niðurgang. Ristilspeglun sýndi loftfylltar blöðrur í fall- og bugaristli. Konunni var gefið 70% súrefni á maska og hurfu blöðrurnar á tveimur vikum. Ristilloftblöðrur (pneumatosis coli) er sjaldgæfur góðkynja sjúkdómur, sem einkennist af blöðrum í hálubeði og slímubeöi ristils. Orsök er óþekkt en sjúkdómurinn hefur verið tengdur ýmsum meltingarfærasjúkdómum, kviðaraðgerðum og lungnasjúkdómum. Meingerðin er einnig óþekkt en þrjár kenningar hafa verið settar fram. Einkenni erir kviðverkir, niðurgangur, vindgangur og blæðing frá ristli. Greining fæst með röntgenmynd, tölvusneiðmynd eða ristilspeglun. Meðferðin er háskammtasúrefnisgjöf í eina til tvær vikur en stundum er skurðaðgerð nauðsynleg. Horfur eru góðar en viss hætta er á endurtekningu.