J Korean Soc Clin Toxicol.  2017 Jun;15(1):56-59. 10.22537/jksct.2017.15.1.56.

Pneumatosis Cystoides Intestinales and Portomesenteric Venous Gas following Anticholinesterase Pesticide Poisoning

• Lee SH
• Lee KW
• Jung JH

• KMID: 2386867
• DOI: http://doi.org/10.22537/jksct.2017.15.1.56

Abstract

Pneumatosis cystoides intestinalis and portomesenteric venous gas are uncommon radiological findings, but are found commonly in cases of bowel ischemia, or as a result of various non-ischemic conditions. A 72-year-old man visited an emergency center with altered mental status 2 hours after ingestion of an unknown pesticide. On physical examination, he showed the characteristic hydrocarbon or garlic-like odor, miotic pupils with no response to light, rhinorrhea, shallow respiration, bronchorrhea, and sweating over his face, chest and abdomen. Laboratory results revealed decreased serum cholinesterase, as well as elevated amylase and lipase level. We made the clinical diagnosis of organophosphate poisoning in this patient based on the clinical features, duration of symptoms and signs, and level of serum cholinesterase. Activated charcoal, fluid, and antidotes were administered after gastric lavage. A computerized tomography scan of the abdomen with intravenous contrast showed acute pancreatitis, poor enhancement of the small bowel, pneumatosis cystoides intestinalis, portomesenteric venous gas and ascites. Emergent laparotomy could not be performed because of his poor physical condition and refusal of treatment by his family. The possible mechanisms were believed to be direct intestinal mucosal damage by pancreatic enzymes and secondary mucosal disruption due to bowel ischemia caused by shock and the use of inotropics. Physicians should be warned about the possibility of pneumatosis cystoides intestinalis and portomesenteric venous gas as a complication of pancreatitis following anticholinesterase poisoning.

Keyword

Anticholinesterase; Pancreatitis; Pneumatosis cystoides intestinalis; Poisoning; Portomesenteric venous gas

MeSH Terms

Abdomen
Aged
Amylases
Antidotes
Ascites
Charcoal
Cholinesterases
Diagnosis
Eating
Emergencies
Gastric Lavage
Humans
Ischemia
Laparotomy
Lipase
Odors
Organophosphate Poisoning
Pancreatitis
Physical Examination
Pneumatosis Cystoides Intestinalis
Poisoning*
Pupil
Respiration
Shock
Sweat
Sweating
Thorax
Treatment Refusal
Amylases
Antidotes
Charcoal
Cholinesterases
Lipase