Pneumatosis cystoides intestinalis (PCI)

Pneumatosis cystoides intestinalis induced by the alpha-glucosidase inhibitor complicated from sigmoid volvulus in a diabetic patient

INTRODUCTION

We present the case of a diabetic patient on treatment with acarbose who had presented a sigmoid volvulus with localized cystic pneumatosis of the sigmoid colon.

CASE REPORT

A 72-year-old patient with a medical history of atrial fibrillation, DNID in treatment since 10 years by acarbose. The patient was admitted to the emergency for abdominal pain and occlusive syndrome since 48 h without fever or nausea or vomiting. A CT scan was performed that showed a dolichocolon with a sigmoid volvulus. The colonic wall was thickening as well as submucosal and subserosal gas, without extra digestive air or collections. A rectosigmoidoscopy was achieving that showed a sigmoid volvulus with multiple small projections like a submucosa gas bubbles. A laparoscopic non-oncologic sigmoidectomy with primary termino terminal colorectal anastomosis was performed. During the surgical procedure, an aspect of PCI of the sigmoid colon was found. The sigmoid colon was long like a dolichocolon, dilated, and partially twisted.

DISCUSSION

PCI is a rare condition characterized by the presence of multiple pneumokystes at different layers of the colonic wall. In emergency setting, the presence of colonic pneumatosis precludes the differential diagnosis between the PCI and mesenteric ischemia or ischemic colitis. It can be the cause of unnecessary explorative laparotomy.

CONCLUSION

PCI is rare disease, in emergency setting, we had to consider in differential diagnosis with colonic vascular disorders.

A Case of Intussusception Associated with Pneumatosis Cystoides Intestinalis

Pneumatosis cystoides intestinalis (PCI) is an uncommon disease that generally lacks symptoms and is rarely associated with intussusception. A 29-year-old man visited our hospital for right upper abdominal pain. Computed tomography (CT) scan revealed multiple air-filled cysts along the intestinal wall and a pseudokidney sign in the transverse colon. A gastrographin enema examination showed a so-called crab finger appearance and multiple elevated translucency in the transverse colon. From these findings, the diagnosis of intussusception associated with PCI was made. The enema and manipulative reduction improved the intussusception. Comparing the enema findings before and after the reduction, we thought that mobile cecum could play an important role in the intussusception. Colonoscopy was performed after the reduction and showed multiple elevated lesions in the ascending colon, which were similar to cluster of grapes. The CT scan of the next day revealed no recurrence of the intussusception, and the patient has not had symptoms of recurrence ever since.

[Intestinal cystic pneumatosis secondary to a peptic ulcer: report of three cases]

La pneumatose kystique intestinale (PNK) est une pathologie rare qui se caractérise par la présence de kystes gazeux dans la paroi intestinale. Elle est asymptomatique ou pauci symptomatique, et le plus souvent découverte lors d'un examen d'imagerie ou d'endoscopie. Nous rapportons une série de trois cas de pneumatose kystique secondaire à un ulcère peptique. A travers ce travail nous essayons de mettre la lumière sur les différents aspects cliniques, radiologiques et thérapeutiques de cette pathologie.

Postoperative pneumoperitoneum after colorectal surgery: Expectant vs surgical management

Postoperative pneumoperitoneum poses a clinical dilemma. Depending on the cause, its management includes a spectrum from simple observation and supportive care to surgical exploration. The aim of this paper is to present four clinical cases and propose an algorithm for the management of postoperative pneumoperitoneum based on available literature. The causes, diagnosis and possible complications arising from pneumoperitoneum will also be discussed. Three of the four cases presented were successfully managed conservatively and one had an exploratory laparotomy with negative findings. In such scenarios, it is important to consider the nonsurgical causes of pneumoperitoneum, which include pseudopneumoperitoneum, thoracic, abdominal, gynecological and idiopathic. These causes do not always require emergent exploratory laparotomy. The surgical team needs to consider the history, physical exam and diagnostic workup of the patient. If a patient presents with peritoneal signs, then exploratory laparotomy is a must. Since 10% of the cases of pneumoperitoneum are caused by nonsurgical entities, managed expectantly, a negative exploratory laparotomy and its associated risks are avoided.

Pneumatosis coli complicated with intussusception in an adult: report of a case

Pneumatosis intestinalis (PI) is a rare condition of unclear etiology affecting the intestinal tract; possible complications include obstruction, intussusception, volvulus, hemorrhage, and intestinal perforation. Pneumatosis intestinalis can occur as a primary idiopathic disease or as a condition secondary to various gastrointestinal and pulmonary diseases. This report presents an uncommon case of PI complicated with intussusception of the ascending colon in a male patient who underwent surgery for suspected lipomatosis that was histologically diagnosed as pneumatosis coli. Since the patient suffered from no other disorder, he was finally diagnosed as having primary PI. Physician awareness of this rare condition is essential in order to avoid a misdiagnosis and unnecessary surgical treatment.

Management algorithm for pneumatosis intestinalis and portal venous gas: treatment and outcome of 88 consecutive cases

BACKGROUND

Pneumatosis intestinalis (PI) and portal venous gas (PVG) historically mandated laparotomy due to the high mortality rate associated with mesenteric ischemia. Computed tomography (CT) can identify PI/PVG in patients with ischemic emergencies and benign idiopathic conditions.

METHODS

A consecutive series of patients with PI or PVG was reviewed from a single institution over 5 years. Eighty-eight cases of PI/PVG were studied: 74 initial patients (year 1-4) were used to generate a treatment algorithm and fourteen additional cases were used to test the algorithm.

RESULTS

PI and PVG were associated with three major clinical subgroups: mechanical causes (n=29), acute mesenteric ischemia (n=29), and benign idiopathic (n=26); four were unclassifiable. Patients with acute mesenteric ischemia were associated with abdominal pain (p=0.01), elevated lactate (>or=3.0 mg/dL; p=0.006), small bowel PI (p=0.04), and calculated vascular disease score (p<0.0005). The three subgroups could be distinguished using the generated algorithm with a sensitivity of 89%, specificity of 100%, and positive predictive value of 100%.

CONCLUSIONS

With greater sensitivity of modern CT scans, PI and PVG are being detected in patients with a wide range of surgical and non-surgical conditions. This clinical algorithm can identify subgroups to direct surgical intervention for acute ischemic insults and prevent non-therapeutic laparotomies for benign idiopathic PI and PVG.

Management algorithm for pneumatosis intestinalis and portal venous gas: treatment and outcome of 88 consecutive cases

BACKGROUND

Pneumatosis intestinalis (PI) and portal venous gas (PVG) historically mandated laparotomy due to the high mortality rate associated with mesenteric ischemia. Computed tomography (CT) can identify PI/PVG in patients with ischemic emergencies and benign idiopathic conditions.

METHODS

A consecutive series of patients with PI or PVG was reviewed from a single institution over 5 years. Eighty-eight cases of PI/PVG were studied: 74 initial patients (year 1-4) were used to generate a treatment algorithm and fourteen additional cases were used to test the algorithm.

RESULTS

PI and PVG were associated with three major clinical subgroups: mechanical causes (n=29), acute mesenteric ischemia (n=29), and benign idiopathic (n=26); four were unclassifiable. Patients with acute mesenteric ischemia were associated with abdominal pain (p=0.01), elevated lactate (>or=3.0 mg/dL; p=0.006), small bowel PI (p=0.04), and calculated vascular disease score (p<0.0005). The three subgroups could be distinguished using the generated algorithm with a sensitivity of 89%, specificity of 100%, and positive predictive value of 100%.

CONCLUSIONS

With greater sensitivity of modern CT scans, PI and PVG are being detected in patients with a wide range of surgical and non-surgical conditions. This clinical algorithm can identify subgroups to direct surgical intervention for acute ischemic insults and prevent non-therapeutic laparotomies for benign idiopathic PI and PVG.

Pneumatosis cystoides intestinalis after fluorouracil chemotherapy for rectal cancer

Pneumatosis cystoides intestinalis (PCI) is a relatively rare condition characterized by intraluminal gas in the gastrointestinal tract. Several chemotherapeutic agents have been reported to be associated with PCI, although fluorouracil-related PCI is extremely rare. We report a case of a 76-year old man who received adjuvant chemotherapy for rectal cancer with fluorouracil (FU) and leucovorin (LV). After 1 cycle of the treatment, he presented with diarrhea and abdominal pain. Abdominal radiogram revealed the presence of free air under the diaphragm and intramural gas in the intestine. Laparotomy was performed, showing a suspected diagnosis of perforation in the gastrointestinal tract. Intraoperative findings revealed pneumatosis of the intestine without evidence of perforation. He was treated supportively and his symptoms improved. In conclusion, we should consider the possibility of PCI occurring in patients with malignancies during chemotherapy treatment.

Acute colonic pseudo-obstruction (Ogilvie’s-syndrome) and Pneumatosis intestinalis in a kidney recipient patient

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is a clinical entity characterized by massive nontoxic dilatation of the colon in the absence of mechanical obstruction and is associated with increased morbidity and mortality in the immunosuppressed patient. We present a case of a kidney transplant recipient developing a life-threatening condition with acute colonic pseudo-obstruction associated with radiologic findings of a linear pneumatosis intestinalis (PI). Urgent laparotomy and resection of the dilated cecum, colon ascendens and transversum was performed because of bowel necrosis with multiple serosal defects. Stool cultures and special stains for microorganisms were all negative, and there was no evidence for viral or fungal infection. The patient was discharged 31 days after transplantation with normal renal function. In conclusion, this steroid-induced ileus (pseudo-obstruction) is a potentially malignant early form of colonic dysmotility rarely reported in transplant recipients. Awareness and early recognition of the condition are critical for a successful outcome. Colonoscopic decompression can achieve reversal of colonic dilatation in most cases, but in some patients prophylactic laparotomy is indicated for prevention of the catastrophic consequences of perforation.

[A pneumatosis cystoides coli revealed by a pseudo-obstruction]

Pneumatosis Intestinalis is a rare benign and often asymptomatic disease; we report the case of a 74 year-old woman with a pneumatosis coli revealed by a pseudo-obstruction; the diagnosis was suspected at radiology. The course under medical treatment was uneventfull.

Pneumatosis cystoides intestinalis: a rare cause of nonsurgical pneumoperitoneum in an infant

The authors describe a 3-year-old boy with pneumatosis cystoides intestinalis (PCI) and associated duodenal stenosis who came to them with abdominal pain, significant abdominal distension, large gastric residue, and pneumoperitoneum. PCI is a rare condition in children characterized by the presence of multiple gas-filled cysts within the wall of some part of gastrointestinal tract that may break and cause pneumoperitoneum without an intestinal perforation. Even if in most cases the standard treatment is surgical, to keep in mind this rare condition could be useful to adopt a most rational treatment approach and avoid unnecessary operation in case of "benign" pneumoperitoneum.

Intestinal obstruction in an elderly man

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Pneumatosis cystoides intestinalis in intestinal pseudoobstruction. Resolution after therapy with metronidazole

A 66-year-old man with chronic idiopathic intestinal pseudoobstruction was admitted for pneumatosis cystoides intestinalis, complicated by pneumoperitoneum. The latter conditions resolved after treatment with metronidazole. There was no favorable effect of the prokinetic agents cisapride and erythromycin. To the authors' knowledge, this is the first reported case of successful treatment of pneumatosis cystoides intestinalis with metronidazole in primary chronic intestinal pseudoobstruction.