Case 198

 Case 1
An eighty-year-old male was transported to our hospital by ambulance for aspiration pneumonia. He had no relatives and lived alone in nursing home for elderly. He suffered from various diseases: chronic cardiac failure, chronic renal disease, hypertension, post-brain infarction sequelae and schizophrenia. Because of motivation loss and lying in bed for long time, he fell into sarcopenia (muscle volume loss) and received percutaneous endoscopic gastrostomy (PEG) last fall. After admission, he swallowed water and vomited massive water like fountain. His respiration state worsened and got oxygen mask of 4 ml/min. Laboratory test revealed white blood cells 13370/mm³, neutrophils 86.8%, CRP 13.09 mg/dL, LDH 167 U/L. He received CT for further examination (Figs 1-3).

Case 2
An eighty nine-year-old female was transported from nursing home to our hospital for thoracic pain and cardiac failure. She had thalamic hemorrhage, hydrocephalus after ventricular-peritoneal shunt, permanent tracheotomy after surgical operation for advanced thyroid cancer. After her cardiac failure improved, she stayed for a long while for rehabilitation after brain stroke sequelae. Twenty eight days later, she vomited and felt abdominal pain. Laboratory test revealed white blood cells 9370/mm³, neutrophils 85.9, LDH 244 U/L. She received abdomen CT for further examination (Figs 4-6).

What is your clinical diagnosis?

1.　Air cholangiogram

2.　Portal venous gas

3.　Gastric abscess

4.　Digestive organ necrosis

5.　Pneumatosis intestinalis

answer

2020.7.15