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Peixoto A, Pereira R, Leitão J. Idiopathic pneumatosis cystoides coli: An uncommon cause of pneumoperitoneum. Radiol Case Rep 2022; 17:4408-4412. [PMID: 36188071 PMCID: PMC9520510 DOI: 10.1016/j.radcr.2022.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare entity characterized by the presence of gaseous cystic within the intestinal wall. The primary or idiopathic type represents 15% of cases and is a self-limited or chronic benign entity. The secondary type represents 85% of cases and is associated with various factors, such as surgery, pharmacotherapy, chemotherapy, autoimmune diseases, inflammatory diseases, and pulmonary illness. Pneumatosis cystoides intestinalis affects the colon (pneumatosis cystoides coli) in about half of the cases. The differential diagnosis of PCI includes potentially life-threatening diseases that cause pneumatosis intestinalis. The misdiagnosis of PCI is common and can lead to unnecessary treatments and surgical procedures. We describe an asymptomatic pneumoperitoneum incidentally seen on chest radiograph. The cause was pneumatosis cystoides coli, which did not require treatment.
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Kumagai S. [Epidemiological characteristic of occupational pneumatosis cystoides intestinalis]. SANGYO EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2015; 57:40-44. [PMID: 25740423 DOI: 10.1539/sangyoeisei.a14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Shinji Kumagai
- Department of Management of Occupational Safety and Health, University of Occupational and Environmental Health, Japan
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Kwon HJ, Won Kim K, Song GW, Hwang S, Ha HK, Lee SG. Uncommon gastrointestinal complications after liver transplantation: radiologic findings and clinical features. Acta Radiol 2013; 54:1-7. [PMID: 23125393 DOI: 10.1258/ar.2012.120522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are various uncommon gastrointestinal complications, as liver transplantation becomes increasingly popular as the only curative method for patients with end-stage liver diseases. It is important for radiologists evaluating postoperative liver transplantation recipients to have a perspective on the possible gastrointestinal complications after liver transplantation and their radiologic features for early detection and early treatment. This article illustrates radiologic findings and clinical features of various uncommon gastrointestinal complications after liver transplantation.
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Affiliation(s)
- Heon-Ju Kwon
- Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - Kyoung Won Kim
- Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Gi-Won Song
- Liver Transplantation Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Hwang
- Liver Transplantation Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Kwon Ha
- Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Sung Gyu Lee
- Liver Transplantation Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Pneumatosis intestinalis after liver transplantation. Eur J Radiol 2011; 80:629-36. [DOI: 10.1016/j.ejrad.2010.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 07/21/2010] [Accepted: 08/02/2010] [Indexed: 12/18/2022]
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Katada Y, Isogai J, Ina H, Tezuka M, Umehara I, Shibuya H. Potential extraperitoneal space continuous with the peri-intestinal space: CT evidence and anatomical evaluation in patients with pneumatosis intestinalis without intestinal ischemia. Surg Radiol Anat 2009; 31:707-13. [PMID: 19415159 DOI: 10.1007/s00276-009-0511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Extraperitoneal spaces, such as the mesenteric space and the retroperitoneal space, can serve as areas that enable a reduction in the pressure exerted by extraperitoneal fluid collection and infiltrating diseases. In clinical practice, understanding the existence of these decompression spaces (or pathways) is very important for making accurate diagnoses. Here, we evaluated potential anatomical extraperitoneal spaces based on the extraluminal gas distribution in patients with pneumatosis intestinalis without intestinal ischemia. METHODS The computed tomography scans of ten patients with pneumatosis intestinalis without intestinal ischemia were reviewed, and the anatomic location of the extraluminal gas distribution was investigated. RESULTS Four patients were diagnosed as having pneumatosis intestinalis of the small intestine and six were diagnosed as having pneumatosis intestinalis of the large intestine. Mesenteric pneumatosis was observed in nine (90%) of the ten patients. The potential anatomical extraperitoneal spaces (or decompression pathways) were classified as follows: mesenteric (n = 3), retroperitoneal (n = 4), and direct (n = 5). CONCLUSIONS The distributions of the extraluminal gas were classified into three categories, and each location may characterize a different decompression pathway. The existence of a potential extraperitoneal space continuous with the peri-intestinal space was confirmed in living subjects.
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Affiliation(s)
- Yoshiaki Katada
- Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Abstract
Pneumatosis cystoides intestinalis (PCI) is an unusual condition that is characterized pathologically by multiple thin-walled, noncommunicating, gas-filled cysts in the submucosal or subserosal layer of the gastrointestinal wall. This paper describes the interesting CT colonographic findings of two patients with PCI, showing multiple gas-filled cysts in the colonic wall.
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Affiliation(s)
- Kyoung Min Kim
- Department of Radiology, Korea University Guro Hospital, 80 Guro-Dong, Guro-Ku, Seoul, 152-703, South Korea
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Abstract
Pneumatosis cystoides coli (PCC) is an uncommon condition in which multiple gas-filled cysts in the walls of the colon. Patients with PCC initially complain of various symptoms including abdominal discomfort, constipation, diarrhea, hematochezia, vomiting, and fever. We recently diagnosed PCC by computed tomography (CT) colonography in 2 patients. Two patients visited the outpatient clinic presenting with hematochezia, diarrhea, or abdominal pain. No underlying cause of PCC was found. Colonoscopy revealed multiple submucosal nodules covered with normal mucosa in the colon. However, CT colonography showed multiple gas-filled cysts within the walls of colon.
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Tuite DJ, Byrne A, Colhoun E, Torreggiani WC. Pneumatosis intestinalis and portal-venous gas: an unusual presentation of acute appendicitis. ACTA ACUST UNITED AC 2007; 51 Spec No.:B137-9. [PMID: 17875136 DOI: 10.1111/j.1440-1673.2007.01848.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pneumatosis Intestinalis in association with portal venous gas is a very rare finding in children and young adults. When present, it is typically associated with bowel infarction and carries a poor prognosis. We present an extremely unusual case where imaging revealed extensive pneumatosis intestinalis and portal venous gas in a patient with acute appendicitis.
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Affiliation(s)
- D J Tuite
- Department of Radiology, Adelaide and Meath Hospitals, Incorporating The National Children's Hospital, Tallaght, Dublin, Ireland
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Oktar SO, Yücel C, Erbaş G, Ozdemir H. Use of twinkling artifact in sonographic detection of intestinal pneumatosis. ACTA ACUST UNITED AC 2005; 31:293-6. [PMID: 16317497 DOI: 10.1007/s00261-005-0021-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 04/13/2005] [Indexed: 11/25/2022]
Abstract
Intestinal pneumatosis is a relatively rare condition that has been associated with a wide variety of abnormalities. Traditionally, this entity has been diagnosed by radiographic films, contrast series, or more accurately by computed tomography. However, reports describing findings of intestinal pneumatosis on sonographic examination, which is an important initial diagnostic tool for abdominal diseases, are limited. We suggest that twinkling artifact may be of value in the sonographic diagnosis of this condition. We report two cases of intestinal pneumatosis that were diagnosed initially by sonography with the aid of twinkling artifact.
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Affiliation(s)
- S O Oktar
- Department of Radiology, Gazi University, School of Medicine, Besevler, Ankara 06510, Turkey.
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Nakamura K, Ohmori Y, Okamoto M, Akioka K, Ushigome H, Kadotani Y, Yoshimura N. Renal transplant recipient experiencing pneumatosis cystoides intestinalis: a case report. Transplant Proc 2003; 35:297-9. [PMID: 12591410 DOI: 10.1016/s0041-1345(02)03915-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- K Nakamura
- Department of Organ Transplant and Endocrine Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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11
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Gallego León JI. Casos en imagen 2.—Neumatosis quística inestinal. RADIOLOGIA 2002. [DOI: 10.1016/s0033-8338(02)77771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parra JA, Acinas O, Bueno J, Madrazo C, Fariñas C. An unusual form of pneumatosis intestinalis associated with appendicitis. Br J Radiol 1998; 71:326-8. [PMID: 9616245 DOI: 10.1259/bjr.71.843.9616245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A rare case of pneumatosis intestinalis is described in a patient with appendicitis. Gas in the colonic wall, epiploic appendices and mesentery caused a new appearance not previously reported on plain radiography or CT. The relevance of an associated redundant right colon is also discussed.
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Affiliation(s)
- J A Parra
- Department of Radiology, Hospital Sierrallana, Cantabria, Spain
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Boerner RM, Fried DB, Warshauer DM, Isaacs K. Pneumatosis intestinalis. Two case reports and a retrospective review of the literature from 1985 to 1995. Dig Dis Sci 1996; 41:2272-85. [PMID: 8943984 DOI: 10.1007/bf02071412] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pneumatosis intestinalis (PI) is characterized by subserosal or submucosal gas-filled cysts of the gastrointestinal tract. The course may be benign or may lead to the need for urgent surgery. Knowledge of the differential diagnosis, course, and treatment modalities are key in providing optimal care to patients who present with this entity. In this article, two cases of "benign" pneumatosis seen at our institution over a one-month period are presented, along with a retrospective review of the English literature from January 1985 to March 1995. Incidence, symptoms, gross and microscopic appearance, radiographic appearance, etiology, differential diagnosis and therapy are reviewed.
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Affiliation(s)
- R M Boerner
- Department of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill 27559, USA
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Yamada CY, Sacknoff R, Novelline RA. Pneumatosis intestinalis in association with sigmoid volvulus: Value of lung windows during abdominal computed tomography. Emerg Radiol 1996. [DOI: 10.1007/bf01507741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scheidler J, Stäbler A, Kleber G, Neidhardt D. Computed tomography in pneumatosis intestinalis: differential diagnosis and therapeutic consequences. ABDOMINAL IMAGING 1995; 20:523-8. [PMID: 8580746 DOI: 10.1007/bf01256704] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Case reports of five patients with pneumatosis intestinalis diagnosed by computed tomography (CT) are presented. Etiology, differential diagnoses, and clinical consequences arising from CT imaging are discussed. In four of the patients, pneumatosis was found to be secondary to gastric ulcer, colon carcinoma, metastasis in the mesentery, and trauma-induced mesenteric ischemia. In one patient, the etiology remained elusive. Using CT, both the extent and the distribution pattern of pneumatosis could be depicted, allowing for differentiation of primary and secondary forms and assessment of prognosis. Evaluation with a lung window is a pre-requisite for reliable diagnosis of pneumatosis with CT. The presence of gas in the mesenteric or portal venous system in mesenteric ischemia is indicative of an unfavorable prognosis.
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Affiliation(s)
- J Scheidler
- Department of Diagnostic Radiology, University of Munich, Klinikum Grosshadern, Germany
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