Zusammenfassung
Die intraabdominelle Druckerhöhung beim Aufbau eines Pneumoperitoneums beeinflusst auch die Durchblutung der intraabdominellen Organe. Wie groß diese Durchblutungsänderung ist und in welchem Ausmaß sie eine Funktionsstörung oder sogar Schädigung der viszeralen Organe verursacht, ist bisher nicht eindeutig geklärt. Sowohl Jaffe und Russell[20] als auch Paul et al.[30] beschrieben eine intestinale Durchblutungsstörung einige Tage nach laparoskopischer Cholezystektomie. Es handelte sich jedesmal um ältere Patienten (68 und 76 Jahre) mit Bluthochdruck und einer langandauernden, eher unspezifischen abdominellen Symptomatik. Beide Patienten wurden wegen einer Darmischämie einige Tage nach der laparoskopischen Cholezystektomie reoperiert und hatten einen fatalen Verlauf. Von den Autoren beider Fallberichte wurde zur Vorsicht gemahnt, weil sie befürchteten, dass eine durch den erhöhten IAP induzierte Durchblutungsverminderung einer intestinalen Ischämie bei vorerkrankten Patienten Vorschub leisten könnte.
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Böhm, B., Junghans, T. (2000). Durchblutung der Leber und des Gastrointestinaltraktes. In: Böhm, B., Schwenk, W., Junghans, T. (eds) Das Pneumoperitoneum. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59713-8_5
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