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Beyene A, Bayissa B, Atalele M, Umer H, Alemu A, Semahegn A. Pneumatosis cystoids intestinalis in a patient with small bowel obstruction: a case report. J Surg Case Rep 2023; 2023:rjad612. [PMID: 38026738 PMCID: PMC10653986 DOI: 10.1093/jscr/rjad612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. A 35-year-old male patient presented with signs and symptoms of intestinal obstruction. Then the patient was diagnosed with pneumatosis cystoides intestinalis. The patient underwent surgery, and antibiotic treatment, and was discharged improved with no incident. Pneumatosis cystoides intestinalis is a surgical condition that resembles other life-threatening top surgical emergencies and affects clinicians' decisions on diagnosis and treatment plans substantially, mainly in low-income countries. So, surgeons have to consider such kind of conditions and avoid the costs and morbidities associated with unnecessary bowel resection or surgery.
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Affiliation(s)
- Andinet Beyene
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Badhaasaa Bayissa
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Mezgebu Atalele
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Hamza Umer
- Department of Surgery, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Addisu Alemu
- Department of Pathology, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Agumasie Semahegn
- College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P.O. Box LG 586, Accra, Ghana
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2
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Yuan C, Teng F, Huang Z, Liu Q, Du L, Xie X, Jiang X, Sheng X. Pneumatosis cystoides intestinalis accompanied by schistosomiasis: a case report. J Int Med Res 2022; 50:3000605221105160. [PMID: 35722835 PMCID: PMC9344114 DOI: 10.1177/03000605221105160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare disease that most frequently occurs in
the large and small intestine and has no obvious clinical symptoms. The main pathological
feature is the presence of air-filled cysts in the intestinal submucosa, intermuscular
wall, and subserous membrane. Conservative treatment is the first choice when no serious
complications are present, whereas timely surgical treatment is needed for serious and
life-threatening complications. This report presents the clinical and pathological
analysis of PCI in a man in his early 90s. The patient was hospitalized because of acute
abdomen and diagnosed with perforation of the sigmoid colon due to PCI with
schistosomiasis after emergency surgery. Emergency partial sigmoid colon resection and
permanent colostomy were performed under general anesthesia. Preoperative diagnosis of PCI
is difficult because of the nonspecific clinical manifestations and endoscopic findings,
and missed diagnosis and misdiagnosis easily occur. Pure PCI has no specific symptoms and
does not require special treatment, and there is a lack of special treatment methods in
clinical practice. However, when PCI is combined with other intestinal diseases such as
schistosomiasis enteropathy, intestinal perforation is likely to occur, leading to severe
acute abdomen with the need for prompt surgical treatment.
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Affiliation(s)
- Chunyan Yuan
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Fei Teng
- Department of Gastrointestinal Surgery, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Zhongyue Huang
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Qiping Liu
- Ultrasonic Department, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Ling Du
- Gastroenterology Endoscope Center, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Xiaoli Xie
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Xuebing Jiang
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai, P. R. China
| | - Xia Sheng
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai, P. R. China
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Lassandro G, Picchi SG, Romano F, Sica G, Lieto R, Bocchini G, Guarino S, Lassandro F. Intestinal pneumatosis: differential diagnosis. Abdom Radiol (NY) 2022; 47:1529-1540. [PMID: 32737548 DOI: 10.1007/s00261-020-02639-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/21/2020] [Accepted: 07/04/2020] [Indexed: 01/04/2023]
Abstract
Intestinal pneumatosis (IP) is an infrequent radiological sign defined as pathological gas infiltration into the bowel wall. It may be associated to different underlying clinical conditions-inflammatory bowel diseases, malignancies, chemotherapy, infections, immune deficiency status, trauma, intestinal ischemia, and necrosis-that are often related to emergency state and require a prompt diagnosis. All the imaging techniques, especially abdominal radiography and Computed Tomography, could detect the presence of IP and discern the forms related to emergency conditions. The differential diagnosis is essential to start an immediate clinical or surgical management and treatment. The aim of this article is to review the radiological features of IP in different illnesses, with particular attention to differential diagnosis.
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Affiliation(s)
- Giulia Lassandro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Naples, Italy
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Abstract
Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.
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5
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Belkhir A, Jrad M, Sebei A, Soudani M, Haddad A, Boukriba S, Frikha W, Mizouni H. Pneumatosis cystoides intestinalis revealed after a hand-to-hand aggression: A case report. Int J Surg Case Rep 2019; 62:100-102. [PMID: 31493662 PMCID: PMC6731346 DOI: 10.1016/j.ijscr.2019.07.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 07/24/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a condition defined by the presence of multiple gas-filled cysts within the intestinal wall. We demonstrated a case of PCI presenting as pneumoperitoneum following a hand-to-hand aggression. Consent was obtained from the patient for publication of this paper. PRESENTATION OF THE CASE This article describes a case of an 28 year-old man with medical history of gastroduodenal ulcer admitted in the emergency room with an acute abdominal pain secondary to a hand-to-hand aggression. Computed tomography (CT-scan) revealed signs of PCI, the presence of pneumoperitoneum and a small amount of fluid in the Douglas pouch. The patient underwent an urgent laparotomy in front of a high suspicion of a bowel perforation. Per operative findings revealed multiple small cysts of the terminal ileum and there were no bowel perforation. DISCUSSION Pneumatosis cystoides intestinalis may be related to a wide spectrum of gastrointestinal conditions. The diagnosis of PCI can be established by endoscopic ultrasound or CT-scan imaging. Management of PCI is conditioned by the clinical and radiological presentation which is essentially related to the primary cause. Conservative approach is allowed in a stable patient with no signs of complications. In the presence of predictive factors of pathologic PCI, namely transmural ischemia and bowel perforation, surgical operation is required. CONCLUSION The management of PCI may be challenging particularly in the presence of pneumoperitoneum. Complications must be excluded before considering a conservative therapy. Therefore, PCI should be interpreted with relevance to the entire clinical context.
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Affiliation(s)
- A Belkhir
- Department of Radiology La Rabta University Hospital, Tunis, Tunisia.
| | - M Jrad
- Department of Radiology La Rabta University Hospital, Tunis, Tunisia.
| | - A Sebei
- Department of Surgery La Rabta University Hospital, Tunis, Tunisia.
| | - M Soudani
- Department of Radiology La Rabta University Hospital, Tunis, Tunisia.
| | - A Haddad
- Department of Surgery La Rabta University Hospital, Tunis, Tunisia.
| | - S Boukriba
- Department of Radiology La Rabta University Hospital, Tunis, Tunisia.
| | - W Frikha
- Department of Radiology La Rabta University Hospital, Tunis, Tunisia.
| | - H Mizouni
- Department of Radiology La Rabta University Hospital, Tunis, Tunisia.
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Di Pietropaolo M, Trinci M, Giangregorio C, Galluzzo M, Miele V. Pneumatosis cystoides intestinalis: case report and review of literature. Clin J Gastroenterol 2019; 13:31-36. [PMID: 31161540 DOI: 10.1007/s12328-019-00999-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022]
Abstract
Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.
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Affiliation(s)
- Marco Di Pietropaolo
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy.
| | - Margherita Trinci
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Carlo Giangregorio
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, L. go Giovanni Alessandro Brambilla 3, 50134, Florence, Italy
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Márquez Argente Del Castillo B, Olalla Muñoz JR. Focal Pneumatosis cystoides intestinalis: optic colonoscopy and virtual colonoscopy features. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:411. [PMID: 29722268 DOI: 10.17235/reed.2018.5522/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pneumatosis intestinalis refers to lineal or cystic gas collections in the intestinal wall. Pneumatosis cystoides intestinalis (PCI) is a benign primary cause. This is a rare disease characterized by multiple gas cysts in the submucosa or subserosa, principally within the colon.
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8
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Venkataramani V, Seif Amir Hosseini A, Schulze MH, Trümper L, Wulf G, Bacher U, Jung W. Intestinal Pneumatosis Associated with Tuberculosis after Allogeneic Hematopoietic Stem Cell Transplantation. Acta Haematol 2016; 137:51-54. [PMID: 27923223 DOI: 10.1159/000452436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022]
Abstract
Pneumatosis intestinalis (PI), defined as intestinal intra- and extramural gas accumulation, is a rare radiographic finding in conditions of intestinal wall damage of varied etiology. Here, we report on a 56-year-old female with multiple myeloma who presented with undulating fever, fluctuating abdominal symptoms, and a distended abdomen 5 months after allogeneic hematopoietic stem cell transplantation (HSCT). Abdominal X-ray and CT scan documented PI with gas accumulation both in the intestinal and colonic bowel walls. Concurrently, thoracic CT revealed mediastinal and bihilar lymphadenopathy associated with bilateral pleural effusions. Microscopy of bronchoalveolar lavage fluid (BALF) revealed acid-fast bacilli, which were identified as Mycobacterium tuberculosis. Tuberculostatic treatment resulted in timely clinical improvement, a complete clearance of the radiological and clinical findings of PI, and the control of the tuberculosis (Tbc), determined by multiple negative BALF results. Taken together, PI occurred as the initial symptom of Tbc in an allogeneic stem cell recipient, achieving complete recovery by tuberculostatic treatment only.
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Affiliation(s)
- Vivek Venkataramani
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Göttingen, Germany
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9
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Khalid F, Kaiyasah H, Binfadil W, Majid M, Hazim W, ElTayeb Y. Pneumatosis intestinalis due to gastrointestinal amyloidosis: A case report & review of literature. Int J Surg Case Rep 2016; 23:29-32. [PMID: 27085104 PMCID: PMC4855412 DOI: 10.1016/j.ijscr.2016.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/28/2016] [Indexed: 12/17/2022] Open
Abstract
Pneumatosis intestinalis is a poorly understood phenomenon with a multitude of causes. It may mimic other gastrointestinal conditions ranging from benign to life threatening ones. A high index of suspicion is required to reach the correct diagnosis in order to provide optimal care for the patient. G.I amyloidosis is among the rare causes for secondary pneumatosis intestinalis.
Introduction Pneumatosis intestinalis (PI) is not a disease but a radiological finding with a poorly understood pathogenesis. It can be divided into primary/idiopathic (15%) or secondary (85%) Kim et al. 2007, based on the factors thought to play a role in its development. Amongst the rare causes of secondary PI is gastrointestinal (GI) amyloidosis. Presentation of the case We report a case of a 46-year-old gentleman who presented with a one month history of acute on chronic abdominal pain, associated with one episode of melena. Upon further investigation, he was found to have pneumoperitoneum. He was taken to the operating theatre, where he was noted to have features of pneumatosis intestinalis of the small bowel with no evidence of bowel perforation. Postoperatively, he underwent an upper GI endoscopy with biopsies that revealed GI amyloidosis. Discussion One of the rare causes that can lead to secondary PI is GI amyloidosis as proven in our case. Patients with symptomatic gastrointestinal amyloidosis usually present with one of four syndromes: gastrointestinal bleeding, malabsorption, protein-losing gastroenteropathy, and, less often, gastrointestinal dysmotility. Conclusion GI amyloidosis is a rare cause of secondary pneumatosis intestinalis. The presentation of the disease varies from patient to patient, therefore, the management should be tailored accordingly.
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Affiliation(s)
- Filza Khalid
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE.
| | - Hadiel Kaiyasah
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Wafa Binfadil
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Maiyasa Majid
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Wessam Hazim
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Yousif ElTayeb
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
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Rathi C, Pipaliya N, Poddar P, Pandey V, Ingle M, Sawant P. A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis. Intest Res 2015; 13:346-9. [PMID: 26576141 PMCID: PMC4641862 DOI: 10.5217/ir.2015.13.4.346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 01/16/2023] Open
Abstract
Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.
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Affiliation(s)
- Chetan Rathi
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Nirav Pipaliya
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Prateik Poddar
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Vikas Pandey
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Prabha Sawant
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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11
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Pneumatosis coli mimicking colorectal cancer. Case Rep Surg 2014; 2014:428989. [PMID: 25400972 PMCID: PMC4220578 DOI: 10.1155/2014/428989] [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: 03/22/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022] Open
Abstract
Pneumatosis coli (PC) is a rare condition of the gastrointestinal tract involving extraluminal gas confined within the bowel wall. We report the case of a 40-year-old gentleman presenting clinically and endoscopically with suspected colorectal cancer. In light of the patient's red flag symptoms, and carpet of polyps seen endoscopically, surgical management by an anterior resection was performed with the patient making a successful recovery. Histological analysis of the resected specimen confirmed pneumatosis coli with no evidence of colonic neoplasia. Although PC can be an incidental finding in asymptomatic patients and considered a benign condition, it can also present as a life-threatening emergency with bowel necrosis and obstruction requiring emergency surgical intervention. Also, when PC mimics malignancy, surgical management is the most appropriate step to ensure that the diagnosis of cancer is not missed.
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12
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Arikanoglu Z, Aygen E, Camci C, Akbulut S, Basbug M, Dogru O, Cetinkaya Z, Kirkil C. Pneumatosis cystoides intestinalis: A single center experience. World J Gastroenterol 2012; 18:453-7. [PMID: 22346251 PMCID: PMC3270504 DOI: 10.3748/wjg.v18.i5.453] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To share our experience of the management and outcomes of patients with pneumatosis cystoides intestinalis (PCI).
METHODS: The charts of seven patients who underwent surgery for PCI between 2001 and 2009 were reviewed retrospectively. Clinical features, diagnoses and surgical interventions of patients with PCI are discussed.
RESULTS: Seven patients with PCI (3 males, 4 females; mean age, 50 ± 16.1 years; range, 29-74 years) were analyzed. In three of the patients, abdominal pain was the only complaint, whereas additional vomiting and/or constipation occurred in four. Leukocytosis was detected in four patients, whereas it was within normal limits in three. Subdiaphragmatic free air was observed radiologically in four patients but not in three. Six of the patients underwent an applied laparotomy, whereas one underwent an applied explorative laparoscopy. PCI localized to the small intestine only was detected in four patients, whereas it was localized to the small intestine and the colon in three. Three patients underwent a partial small intestine resection and four did not after PCI was diagnosed. Five patients were diagnosed with secondary PCI and two with primary PCI when the surgical findings and medical history were assessed together. Gastric atony developed in one case only, as a complication during a postoperative follow-up of 5-14 d.
CONCLUSION: Although rare, PCI should be considered in the differential diagnosis of acute abdomen. Diagnostic laparoscopy and preoperative radiological tests, including computed tomography, play an important role in confirming the diagnosis.
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13
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Intestinal pneumatosis in which CT colonography was of significant diagnostic value: case report. Int Surg 2012; 96:217-9. [PMID: 22216699 DOI: 10.9738/1379.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intestinal pneumatosis refers to the presence of gas in the gastrointestinal wall. It is often difficult to clinically differentiate this condition from gastrointestinal perforation, sometimes resulting in emergency surgery. Imaging studies are important to establish the differential diagnosis. However, there have been few studies showing the efficacy of computed tomography (CT) colonography in diagnosing pneumatosis. We report a case of intestinal pneumatosis in which CT colonography was of significant diagnostic value. A 43-year-old man was referred to our hospital for a detailed investigation of multiple submucosal tumor-like lesions associated with multiple pneumatosis from the cecum to the ascending colon. These lesions were revealed by colonoscopy performed in another hospital on May 21, 2008. Abdominal 3-dimensional CT showed multiple pneumatic lesions from the cecum to the ascending colon, and the patient was diagnosed as having intestinal pneumatosis. The patient is being followed conservatively because he is asymptomatic.
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14
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Azzaroli F, Turco L, Ceroni L, Galloni SS, Buonfiglioli F, Calvanese C, Mazzella G. Pneumatosis cystoides intestinalis. World J Gastroenterol 2011; 17:4932-6. [PMID: 22171137 PMCID: PMC3235639 DOI: 10.3748/wjg.v17.i44.4932] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 04/19/2011] [Accepted: 04/26/2011] [Indexed: 02/06/2023] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare condition that may be associated with a variety of diseases. The presenting clinical picture may be very heterogeneous and represent a challenge for the clinician. In the present paper we describe both a common and an uncommon clinical presentation of PCI and review the pertaining literature. Our cases confirm that, apart from asymptomatic cases, the clinical presentation of PCI may be widely different and suggest that a new onset of stipsis might be the presenting symptom. Diagnosis might be suggested by a simple X-ray of the digestive tract showing a change in the characteristics of the intestinal wall in two-thirds of these patients. However, one third of the patients do not have a suggestive X-ray and require a computed tomography (CT) scan/nuclear magnetic resonance that may reveal a thickened bowel wall containing gas to confirm the diagnosis and distinguish PCI from intraluminal air or submucosal fat. CT also allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of PCI such as bowel wall thickening, altered contrast mucosal enhancement, dilated bowel, soft tissue stranding, ascites and the presence of portal air. Our results also point out that clinicians and endoscopists should be aware of the possible presentations of PCI in order to correctly manage the patients affected with this disease and avoid unnecessary surgeries. The increasing number of colonoscopies performed for colon cancer screening makes PCI more frequently casually encountered and/or provoked, therefore the possible endoscopic appearances of this disease should be well known by endoscopists.
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15
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Clemente G, Chiarla C, Giovannini I, De Rose AM, Astone A, Barone C, Nuzzo G. Gas in portal circulation and pneumatosis cystoides intestinalis during chemotherapy for advanced rectal cancer. Curr Med Res Opin 2010; 26:707-11. [PMID: 20078321 DOI: 10.1185/03007990903566798] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acute abdominal symptoms with CT scan evidence of intramural gas in bowel walls (pneumatosis cystoides intestinalis, PCI) and of gas in the portal venous blood (PBG) in patients undergoing chemotherapy may represent a worrisome picture, suggestive of bowel necrosis. This picture remains a major clinical clue and the reporting of new cases may help to share awareness and experience on management. We describe a patient with acute abdominal symptoms and evidence of PCI with PBG under cetuximab, oxaliplatin, tegafur-uracil and folinic acid chemotherapy for metastatic adenocarcinoma of the rectosigmoid junction. METHODS After admission for mucositis with diarrhea and profound dehydration, and subsequent emergency laparotomy for derotation of an intestinal volvulus, on the tenth postoperative day the patient developed fever and abdominal pain, with CT scan evidence of PCI with PBG. The exam of the abdomen did not suggest major problems requiring emergency surgery, and antibiotic treatment with close monitoring were performed, followed by rapid improvement. RESULTS Twelve days later, after resumption of oral diet, the patient unexpectedly suffered a spontaneous jejunal microperforation, requiring emergency laparotomy and bowel resection. Pathology showed that the perforation was within an area of ulceration involving the inner superficial layer of the bowel. Subsequently recovery was normal and at present, after 15 months, the patient is well and continuing chemotherapy. CONCLUSIONS This is probably the first report of PCI with PBG related to intestinal toxicity during cetuximab, oxaliplatin, tegafur-uracil and folinic acid chemotherapy in a patient with advanced rectal carcinoma, followed by delayed small bowel perforation. It provides an example of the challenges involved in the management of this type of patient.
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Affiliation(s)
- G Clemente
- Catholic University of Sacred Heart, Agostino Gemelli Medical School, Rome, Italy.
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Novellas S, Marcotte-Bloch C, Karimdjee BS, Anty R, Chevallier P. [Answer to may e-quid. A medical cause of pneumoperitoneum]. ACTA ACUST UNITED AC 2009; 90:752-4. [PMID: 19623132 DOI: 10.1016/s0221-0363(09)74734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Novellas
- Service d'Imagerie Médicale, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet 2,151, route de Saint-Antoine de Ginestière, BP 3079, 06202 Nice Cedex3
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