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    "textoCompleto" => "<p class="elsevierStylePara">Sr&#46; Director&#58;</p><p class="elsevierStylePara">La secci&#243;n &#8220;Im&#225;genes en Medicina Intensiva&#8221; ha publicado recientemente una radiograf&#237;a simple de abdomen&#44; remitida por Delgado Mart&#237;n et al<span class="elsevierStyleSup">1</span>&#44; sobre un caso de &#8220;neumoperitoneo masivo con desplazamiento diafragm&#225;tico bilateral y dilataci&#243;n col&#243;nica&#8221; secundario a una perforaci&#243;n de colon&#46; En mi opini&#243;n&#44; esta radiograf&#237;a abdominal muestra tambi&#233;n un signo que tiene gran importancia para el diagn&#243;stico y tratamiento de este tipo de pacientes con neumoperitoneo masivo&#58; un desplazamiento inferior y medio del h&#237;gado caracter&#237;stico de los neumoperitoneos a tensi&#243;n &#40;NPT&#41;<span class="elsevierStyleSup">2&#44;3</span>&#46; La imagen de Delgado Mart&#237;n et al<span class="elsevierStyleSup">1</span> es similar a las publicadas anteriormente por Offerman et al<span class="elsevierStyleSup">2</span>&#44; Devine at al<span class="elsevierStyleSup">3</span> y Ortega Carnicer et al<span class="elsevierStyleSup">4</span>&#44; aunque estos &#250;ltimos autores tampoco refirieron la centralizaci&#243;n hep&#225;tica en la descripci&#243;n de su caso&#46;</p><p class="elsevierStylePara">El NPT es una causa rara de s&#237;ndrome compartimental abdominal que puede observarse tras perforaciones espont&#225;neas o iatrog&#233;nicas &#40;tras endoscopias abdominales&#41; de v&#237;sceras huecas o maniobras de resucitaci&#243;n cardiopulmonar con dificultades para la ventilaci&#243;n&#46; El NPT lleva a una r&#225;pida descompensaci&#243;n cardiorrespiratoria&#44; pues la presi&#243;n intraabdominal elevada reduce el retorno venoso por compresi&#243;n de la vena cava inferior y dificulta la ventilaci&#243;n por desplazamiento cef&#225;lico de los diafragmas<span class="elsevierStyleSup">5-7</span>&#46; El diagn&#243;stico exige un alto &#237;ndice de sospecha en pacientes que tienen dificultad respiratoria&#44; colapso hemodin&#225;mico y gran distensi&#243;n abdominal con timpanismo&#46; La radiograf&#237;a simple de abdomen permite el diagn&#243;stico definitivo al mostrar un neumoperitoneo masivo junto a un desplazamiento medial del h&#237;gado&#46; Esta centralizaci&#243;n hep&#225;tica ha sido tambi&#233;n observada por Ortega-Carnicer et al<span class="elsevierStyleSup">8</span> en la tomograf&#237;a computarizada de abdomen de un paciente con NPT debido a una perforaci&#243;n g&#225;strica&#46;</p><p class="elsevierStylePara">El &#8220;taponamiento abdominal agudo&#8221; secundario a un NPT exige un tratamiento inmediato mediante punci&#243;n con aguja de la pared abdominal&#44; incluso si el diagn&#243;stico no ha sido confirmado radiol&#243;gicamente&#44; y a la espera del tratamiento definitivo<span class="elsevierStyleSup">2&#44;3&#44;8</span>&#46;</p>"
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