Experience of MDT in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Jiang , ZHU Shiyu , SONG Sikai , ZHANG Wang , Bilaliding ,  ZHANG Jun

Department of Abdominal Surgery, Occupational Disease Hospital in Xinjiang, Urumqi, Xinjiang Uygur Autonomous Region 830000, P. R. China;

Corresponding?author：

ZHANG Jun, Email: zhangjun7530263@sina.com

Keywords：

intrahepatic pneumatosis; hepatoportal pneumatosis; intrahepatic bile duct pneumatosis; multidisciplinary team

DOI：

10.7507/1007-9424.201901020

Video：

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Objective To summarize experience of multidisciplinary team (MDT) in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis and explore its clinical differentiation with other common types of intrahepatic pneumatosis.Method The clinicopathologic data of rare patient with circumscriptus intrahepatic pneumatosis admitted to the Occupational Disease Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed.Results A 60-year old female patient was admitted to this hospital with " abdominal pain and septic shock”. After the MDT discussion and analysis, the treatment regimens were decided as follows: the early anti-shock treatment, corrections of electrolyte disorder and hypoalbuminemia, platelet transfusion, ultrasound guided percutaneous catheter drainage (200 mL gas and 10 mL pus, the pneumonic Klebsiella which proved by the bacterial culture). The drainage tube was removed on postoperative day 6. After 5 d of the anti-inflammatory treatment with imipenem and statin sodium injection, it was downgraded to the cefazoxime (the third-generation cephalosporin) injection, and the anti-inflammatory treatment was continued for 6 d as well as the blood glucose was controlled. On the 7th day after the treatment, the right upper abdomen pain was relieved and without positive sign. The abdominal CT showed the localized pneumoconiosis in the right lobe of the liver was completely absorbed. The result of laboratory examination was basically normal. The patient was discharged on the 12th day after the operation and had no discomfort symptoms on month 1 after the operation. The abdominal CT showed the liver was not abnormal.Conclusion Surgeons should be fully aware of various types of intrahepatic pneumatosis so as to sufficiently investigate pathophysiological clue of disease to improve cure rate and reduce complications.

Citation： ZHU Jiang, ZHU Shiyu, SONG Sikai, ZHANG Wang, Bilaliding, ZHANG Jun. Experience of MDT in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(5): 589-594. doi: 10.7507/1007-9424.201901020 Copy

1.	王凇, 郝艷紅, 楊薇, 等. 肝癌射頻消融后肝膿腫的發生率及危險因素分析. 中國介入影像與治療學, 2018, 15(1): 37-41.
2.	胡賢鏵, 廖彩虹, 張云軒. 多層螺旋 CT 掃描在不典型肝膿腫診斷中的價值. 中國繼續醫學教育, 2018, 10(21): 46-48.
3.	廖政戎. 肝膿腫合并 2 型糖尿病的臨床特征分析及療效評估. 糖尿病新世界, 2018, 21(16): 23-24.
4.	邊芳. 肝膿腫的 CT 診斷及臨床鑒別. 現代醫用影像學, 2018, 27(2): 561-562.
5.	史鳳霞, 劉建濱, 郭一清. 膽囊內瘺的影像表現. 臨床放射學雜志, 2018, 37(3): 424-427.
6.	楊艷, 周中銀, 姬盼盼, 等. 膽囊結腸瘺的診治進展. 醫學研究雜志, 2016, 45(11): 191-193.
7.	王曉東, 劉洋, 徐剛. 門靜脈積氣的 CT 影像表現及臨床意義. 中國醫療前沿, 2012, 7(9): 67, 61.
8.	劉靈軍, 于洋, 李肖. 門靜脈積氣臨床與影像學研究進展. 中華臨床醫師雜志 (電子版), 2011, 5(23): 7061-7063.
9.	張瑩, 劉欣, 張文耀, 等. 螺旋 CT 檢查急性缺血性腸病所致門靜脈和腸壁積氣的表現特點及其臨床診斷價值研究. 實用肝臟病雜志, 2018, 21(5): 793-796.
10.	于濤, 薛娟, 劉莉娜, 等. 急性重型減壓病致肝內多發積氣的 CT 改變. 中華航海醫學與高氣壓醫學雜志, 2018, 25(2): 116-117.
11.	蔡慶虎, 張燕絨, 張海榮, 等. 缺血性腸病所致肝門靜脈和腸壁積氣的螺旋 CT 影像特征與診斷價值. 中華肝膽外科雜志, 2017, 23(5): 296-299.
12.	Abboud B, El Hachem J, Yazbeck T, et al. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol, 2009, 15(29): 3585-3590.
13.	Nelson AL, Millington TM, Sahani D, et al. Hepatic portal venous gas: the ABCs of management. Arch Surg, 2009, 144(6): 575-581.
14.	何佳妹. 彩超對肝內三種常見強回聲病灶的鑒別與診斷研究. 醫學信息, 2018, 31(12): 160-162.
15.	曾邦峰, 余暉. 不典型肝膿腫的影像學表現及鑒別診斷. 醫學綜述, 2017, 23(21): 4342-4346.
16.	邵永良, 鐘麗琴, 孫云峰, 等. CT 檢查在囊性肝內膽管細胞癌與肝膿腫診斷中的作用分析. 健康研究, 2016, 36(2): 150-152.
17.	姚敏學, 馮秋鵬, 鮑磊, 等. 門靜脈積氣一例. 中華急診醫學雜志, 2016, 25(3): 355.
18.	張懷信, 蔣雪峰, 朱玉春, 等. 肝臟門靜脈積氣 1 例. 西南軍醫, 2015, (3): 326-327.
19.	劉遠高, 李昌松, 鐘臺聲. 細菌性肝膿腫的 CT、MRI 影像診斷及鑒別診斷. 中國 CT 和 MRI 雜志, 2014, 12(6): 58-60.
20.	于明安, 梁萍, 于曉玲, 等. 肝內轉移性膽管癌合并膽管積氣微波消融后肝膿腫發生及原因分析. 中國超聲醫學工程學會成立30周年暨第十二屆全國超聲醫學學術大會論文匯編. 西安: 中國超聲醫學工程學會, 2014: 586.
21.	周春, 周建橋, 詹維偉, 等. 門靜脈積氣的超聲表現 (6 例報道及文獻復習). 腫瘤影像學, 2014, 23(2): 133-136.
22.	嚴涵. 肝內膽管積氣臨床超聲診斷與鑒別診斷價值分析. 中國中醫藥咨訊, 2011, 03(18): 459.
23.	李俊華, 任明思. 上消化道穿孔致肝包膜下積液積氣 1 例. 醫學影像學雜志, 2010, 20(6): 822-822, 853.
24.	安劍萍. 肝內膽管積氣的超聲診斷與鑒別診斷. 實用臨床醫學, 2009, 10(8): 82-83, 封 4.
25.	周建橋, 周春, 吳志遠, 等. 門靜脈積氣超聲表現 3 例. 中華超聲影像學雜志, 2006, 15(7): 557.

1. 王凇, 郝艷紅, 楊薇, 等. 肝癌射頻消融后肝膿腫的發生率及危險因素分析. 中國介入影像與治療學, 2018, 15(1): 37-41.
2. 胡賢鏵, 廖彩虹, 張云軒. 多層螺旋 CT 掃描在不典型肝膿腫診斷中的價值. 中國繼續醫學教育, 2018, 10(21): 46-48.
3. 廖政戎. 肝膿腫合并 2 型糖尿病的臨床特征分析及療效評估. 糖尿病新世界, 2018, 21(16): 23-24.
4. 邊芳. 肝膿腫的 CT 診斷及臨床鑒別. 現代醫用影像學, 2018, 27(2): 561-562.
5. 史鳳霞, 劉建濱, 郭一清. 膽囊內瘺的影像表現. 臨床放射學雜志, 2018, 37(3): 424-427.
6. 楊艷, 周中銀, 姬盼盼, 等. 膽囊結腸瘺的診治進展. 醫學研究雜志, 2016, 45(11): 191-193.
7. 王曉東, 劉洋, 徐剛. 門靜脈積氣的 CT 影像表現及臨床意義. 中國醫療前沿, 2012, 7(9): 67, 61.
8. 劉靈軍, 于洋, 李肖. 門靜脈積氣臨床與影像學研究進展. 中華臨床醫師雜志 (電子版), 2011, 5(23): 7061-7063.
9. 張瑩, 劉欣, 張文耀, 等. 螺旋 CT 檢查急性缺血性腸病所致門靜脈和腸壁積氣的表現特點及其臨床診斷價值研究. 實用肝臟病雜志, 2018, 21(5): 793-796.
10. 于濤, 薛娟, 劉莉娜, 等. 急性重型減壓病致肝內多發積氣的 CT 改變. 中華航海醫學與高氣壓醫學雜志, 2018, 25(2): 116-117.
11. 蔡慶虎, 張燕絨, 張海榮, 等. 缺血性腸病所致肝門靜脈和腸壁積氣的螺旋 CT 影像特征與診斷價值. 中華肝膽外科雜志, 2017, 23(5): 296-299.
12. Abboud B, El Hachem J, Yazbeck T, et al. Hepatic portal venous gas: physiopathology, etiology, prognosis and treatment. World J Gastroenterol, 2009, 15(29): 3585-3590.
13. Nelson AL, Millington TM, Sahani D, et al. Hepatic portal venous gas: the ABCs of management. Arch Surg, 2009, 144(6): 575-581.
14. 何佳妹. 彩超對肝內三種常見強回聲病灶的鑒別與診斷研究. 醫學信息, 2018, 31(12): 160-162.
15. 曾邦峰, 余暉. 不典型肝膿腫的影像學表現及鑒別診斷. 醫學綜述, 2017, 23(21): 4342-4346.
16. 邵永良, 鐘麗琴, 孫云峰, 等. CT 檢查在囊性肝內膽管細胞癌與肝膿腫診斷中的作用分析. 健康研究, 2016, 36(2): 150-152.
17. 姚敏學, 馮秋鵬, 鮑磊, 等. 門靜脈積氣一例. 中華急診醫學雜志, 2016, 25(3): 355.
18. 張懷信, 蔣雪峰, 朱玉春, 等. 肝臟門靜脈積氣 1 例. 西南軍醫, 2015, (3): 326-327.
19. 劉遠高, 李昌松, 鐘臺聲. 細菌性肝膿腫的 CT、MRI 影像診斷及鑒別診斷. 中國 CT 和 MRI 雜志, 2014, 12(6): 58-60.
20. 于明安, 梁萍, 于曉玲, 等. 肝內轉移性膽管癌合并膽管積氣微波消融后肝膿腫發生及原因分析. 中國超聲醫學工程學會成立30周年暨第十二屆全國超聲醫學學術大會論文匯編. 西安: 中國超聲醫學工程學會, 2014: 586.
21. 周春, 周建橋, 詹維偉, 等. 門靜脈積氣的超聲表現 (6 例報道及文獻復習). 腫瘤影像學, 2014, 23(2): 133-136.
22. 嚴涵. 肝內膽管積氣臨床超聲診斷與鑒別診斷價值分析. 中國中醫藥咨訊, 2011, 03(18): 459.
23. 李俊華, 任明思. 上消化道穿孔致肝包膜下積液積氣 1 例. 醫學影像學雜志, 2010, 20(6): 822-822, 853.
24. 安劍萍. 肝內膽管積氣的超聲診斷與鑒別診斷. 實用臨床醫學, 2009, 10(8): 82-83, 封 4.
25. 周建橋, 周春, 吳志遠, 等. 門靜脈積氣超聲表現 3 例. 中華超聲影像學雜志, 2006, 15(7): 557.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience of MDT in diagnosis and treatment of rare patient with circumscriptus intrahepatic pneumatosis

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