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Hidroneumomediastino secundario a perforación de vólvulo gástrico en paciente con hernia de hiato gigante
Hydropneumomediastinum Secondary to Gastric Volvulus Perforation in a Patient With Giant Hiatal Hernia
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Entre las causas más habituales están los casos secundarios a iatrogenia y traumatismos, pero se han descrito múltiples etiologías que pueden causar esta entidad, entre las que podemos incluir cetoacidosis diabética, perforación gástrica o esofágica, neumonía, cáncer de pulmón, consumo de cocaína, etc., habiendo incluso algunos casos espontáneos<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos el caso de una mujer de 96<span class="elsevierStyleHsp" style=""></span>años con antecedentes de hipertensión arterial y hernia de hiato que consultó por cuadro de dolor epigástrico y vómitos en posos de café de 6<span class="elsevierStyleHsp" style=""></span>h de evolución. En la exploración física se apreciaba distensión abdominal con dolor a la palpación en epigastrio. La radiografía de tórax reveló la presencia de una cámara gástrica distendida en la cavidad torácica y neumomediastino. La TC toracoabdominal (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>) mostró la cámara gástrica distendida a nivel torácico con la unión gastroesofágica y gastroduodenal por encima del hiato esofágico, así como colecciones de aire y líquido a nivel del mediastino y presencia de enfisema subcutáneo. Estos hallazgos eran compatibles con perforación gástrica secundaria a vólvulo en paciente con hernia hiatal gigante. Debido a la avanzada edad de la paciente se descartó la intervención quirúrgica, falleciendo a las pocas horas del ingreso.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1231 "Ancho" => 933 "Tamanyo" => 146563 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment with subcutaneous drainage in the pneumomediastinum and massive subcutaneous emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Santalla Martínez" 1 => "R. Dacal Quintas" 2 => "P.M. Velázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.09.001" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "127" "paginaFinal" => "128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23142607" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pneumomediastinum and pneumopericardium with respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Kikeeva" 1 => "D. Berrio Grajales" 2 => "E. 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