Pneumatosis intestinalis in children

Pneumatosis intestinalis in children is well documented condition, and is accepted as a manifestation of differing gastrointestinal tract disorders such as mechanical obstruction, vascular disturbances of the bowel with or without bacterial contamination. However, the total spectrum of the mechanisms of production of pneumatosis is not yet fully understood. The presence of pneumatosis in necrotizing enterocolitis is a very serious condition and the mortality rate is very high. Transient ischaemia in infants due to perinatal stress is considered as an important aetiological factor. Gas in the portal venous system and pneumoperitoneum are also well-known associations. Gross peritonitis and perforation of the bowel are regarded as an indication for urgent surgery. Pneumatosis due to other causes follows a benign course, and does not influence the management.

Duplication of the pylorus found concomitantly with achalasia: congenital or peptic etiology?

A patient is presented with true duplication of the pylorus and concomitant achalasia of the esophagus. This patient has never had peptic ulcer disease and is suspected to have a double pyloric anomaly as a congenital abnormality rather than the result of peptic disease and scarring.

Pneumothorax and pneumomediastinum complicating acute miliary tuberculosis

Five adult cases of acute miliary tuberculosis are described. Four were complicated by pneumothoraces and 1 by pneumomediastinum. In 2 cases pneumothorax occurred on the left side while in 2 it was bilateral. None of the 5 patients died.