Neumoperitoneo y gas portal como signos de sospecha de isquemia mesentérica en paciente en programa de hemodiálisis

Resumen

Las complicaciones de la hemodiálisis (HD) engloban todas aquellas enfermedades que aparecen en el paciente asociadas a la técnica dialítica. Las complicaciones agudas son las que aparecen durante la sesión o en las horas siguientes.

Las alteraciones del aparato digestivo, son muy comunes en los pacientes en diálisis, y con frecuencia muy sintomáticas, condicionando una importante morbi/mortalidad, de aquí la importancia, no sólo de diagnosticar y tratar adecuadamente todas las complicaciones que puedan acontecer en relación con la HD, sino también de prevenirlas.

Presentamos un caso de dolor abdominal recidivante, en una paciente en programa de HD, con los hallazgos radiológicos de neumoperitoneo y gas portal, cuya causa no llegó a establecerse y con resultado fatal.

Palabras clave: Hemodiálisis, dolor abdominal, neumoperitoneo, isquemia mesentérica, gas portal.

Abstract

Complications of hemodialysis (HD) encompass all those diseases that the patient suffer associated with the dialysis technique. Acute complications are those that appear during the session or in the next few hours.

Digestive disorders are very common in patients on dialysis, and often very symptomatic, determining a significant morbidity / mortality, hence the importance, not only to adequately diagnose and treat all the complications that may occur in relation with the HD, but also to prevent them.

We report a case of recurrent abdominal pain in a patient on HD, with pneumoperitoneum and portal gas as radiological findings, whose cause could never be established with fatal outcome.

Introduction: The patient on dialysis often suffer high digestive tract diseases. Esophagitis and duodenitis are more common in patients on dialysis than in general population[1]; peptic ulcer and Helicobacter pylori infection have a similar frequency when compared with the general population. The etiology of these disorders is multifactorial, implicating among others, changes in acid secretion caused by hypergastrinemia, bile reflux and impaired blood flow of the gastric mucosa.

These patients also have an increased risk of bleeding due to platelet dysfunction induced by uremia and the intermittent use of heparin during hemodialysis. The most common causes are acute lesions of the gastric mucosa after intake of NSAIDs, followed by gastric angiodysplasia[1].

Diverticular disease is more common in patients with polycystic disease[1]. Faced with lower gastrointestinal bleeding, in addition to the usual causes, we should always think of angiodysplasia or colon ulcers.

The risk of pancreatitis is higher in case of vascular disease, polycystic kidney disease, medicines and hyperparathyroidism[1].

The most common causes of abdominal pain in patients on HD are flatulence and abdominal angina, favored by episodes of hypotension during dialysis in arteriosclerotic patients[1].

Keywords: Hemodialysis, abdominal pain, pneumoperitoneum, mesenteric ischemia, portal gas.