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Erschienen in: Intensive Care Medicine 3/2022

Open Access 20.10.2021 | Imaging in Intensive Care Medicine

Severe pneumatosis intestinalis in a patient with botulism

verfasst von: Lettow Iris, Eichler Lars, Grotelueschen Rainer, Kluge Stefan

Erschienen in: Intensive Care Medicine | Ausgabe 3/2022

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A 34-year-old male patient with confirmed botulism (serotype B, detection in stool sample), on mechanical ventilation for 7 days suffered from severe paralytic ileus despite early treatment with trivalent antitoxin. Under pro-kinetic therapy, acute abdominal guarding developed. Computed tomography (CT) scan showed dilated intestinal loops and a widespread pneumatosis intestinalis with intramural gas in multiple small bowel loops as well as extensive portal gas, especially in the left lobe of the liver (Fig. 1). Explorative laparotomy ruled out intestinal perforation or ischemia. After 7 days of conservative treatment with abdomen apertum, a CT scan confirmed full recovery and surgical closure of the abdomen could be performed. Pathogenesis of pneumatosis intestinalis remains unclear. As previously described for Clostridium perfringens, bacterial invasion of the intestinal wall may have been followed by intramural gas production. An alternative pathogenetic theory postulates intraluminal gas production and subsequent pressure increase as a cause of gas penetration into the intestinal wall. Both pathogenetic mechanisms may be facilitated by locally disturbed integrity of the gut wall on a microscopic level.
While 70% of botulism patients suffer from constipation due to disturbed postganglionic transmission, this case highlights the importance of the often underrated gastrointestinal complications of the disease.

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All authors state that they have no conflicts of interest.

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The patient has consented to the submission of the case report to the journal.
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Metadaten
Titel
Severe pneumatosis intestinalis in a patient with botulism
verfasst von
Lettow Iris
Eichler Lars
Grotelueschen Rainer
Kluge Stefan
Publikationsdatum
20.10.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 3/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-021-06551-7