Brazilian Journal of Anesthesiology
https://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

http://dx.doi.org/10.1590/S0034-70942009000500011 Braz J Anesthesiol, vol.59, n5, p.614-617, 2009
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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

Referencias

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