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Calenda CD, Toohey CR, Levy M, Bhardwaj A, Ubhi J, Sharma A, Abou Rizk F. Pneumatosis Intestinalis, Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, and Pneumobilia After Pembrolizumab Therapy: A Case Report. Cureus 2024; 16:e55972. [PMID: 38601394 PMCID: PMC11004849 DOI: 10.7759/cureus.55972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) are becoming increasingly popular in treating cancers resistant to traditional chemotherapy. While ICIs have shown promise in treating cancer, the class of drugs also comes with certain risks, such as the development of pneumatosis intestinalis (PI) in rare cases. Pembrolizumab, an ICI that inhibits programmed cell death protein 1 (PD-1), has, in some rare instances, caused PI. Patients with ICI-induced PI may also present with pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and pneumobilia. In the current report, we describe the presentation and management of a 50-year-old female with initial complaints of diffuse abdominal pain, constipation, abdominal distension, nausea, and decreased urine output approximately six months after beginning pembrolizumab and two months after the most recent dose of pembrolizumab. Subsequent CT imaging revealed massive PI with pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and pneumobilia suspected to be secondary to pembrolizumab. Here, we discuss the possible mechanisms of ICI-induced PI and evaluate the management of patients presenting with PI and pneumoperitoneum.
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Affiliation(s)
- Charles D Calenda
- Medicine, College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - Cameron R Toohey
- Medicine, College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - Madeline Levy
- Medicine, College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - AyJy Bhardwaj
- General Surgery, Concord Hospital - Laconia, Laconia, USA
| | - Jaspreet Ubhi
- Internal Medicine, Concord Hospital - Laconia, Laconia, USA
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Perrone G, Giuffrida M, Donato V, Petracca GL, Rossi G, Franzini G, Cecconi S, Annicchiarico A, Bonati E, Catena F. The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review. J Pers Med 2024; 14:167. [PMID: 38392601 PMCID: PMC10890206 DOI: 10.3390/jpm14020167] [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: 12/06/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE Pneumatosis intestinalis is a radiological finding with incompletely understood pathogenesis. To date, there are no protocols to guide surgical intervention. METHODS A systematic review of literature, according to PRISMA criteria, was performed. Medline and PubMed were consulted to identify articles reporting on the items "emergency surgery, pneumatosis coli, and pneumatosis intestinalis" from January 2010 up to March 2022. This study has not been registered in relevant databases. RESULTS A total of 1673 patients were included. The average age was 67.1 ± 17.6 years. The etiology was unknown in 802 (47.9%) patients. Hemodynamic instability (246/1673-14.7% of the patients) was associated with bowel ischemia, necrosis, or perforation (p = 0.019). Conservative management was performed in 824 (49.2%) patients. Surgery was performed 619 (36.9%) times, especially in unstable patients with bowel ischemia signs, lactate levels greater than 2 mmol/L, and PVG (p = 0.0026). In 155 cases, surgery was performed without pathological findings. CONCLUSIONS Many variables should be considered in the approach to patients with pneumatosis intestinalis. The challenge facing the surgeons is in truly identifying those who really would benefit and need surgical intervention. The watch and wait policy as a first step seems reasonable, reserving surgery only for patients who are unstable or with high suspicion of bowel ischemia, necrosis, or perforation.
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Affiliation(s)
- Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Mario Giuffrida
- Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Valentina Donato
- Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
| | | | - Giorgio Rossi
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Giacomo Franzini
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Sara Cecconi
- Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
| | | | - Elena Bonati
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, 47023 Cesena, Italy
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Erdem S, Patel SV, Patel D, Patel S, Patel S, Chaudhary AJ. Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia? Cureus 2023; 15:e45330. [PMID: 37849594 PMCID: PMC10577153 DOI: 10.7759/cureus.45330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Pneumatosis intestinalis (PI) is a relatively rare gastrointestinal finding that has a wide variety of causes - ranging from benign to life-threatening. It is described as the pathological presence of gas within the bowel wall with multiple hypotheses emerging as to the likely mechanism. An important indicator of a life-threatening source of PI is the presence of gas within the hepatic portal vein, referred to as hepatic portal venous gas (HPVG). While non-specific for isolated PI, HPVG has been reported in PI patients to be associated with bowel ischemia and is thereby considered an indication for emergent management. Herein we report a case involving an atypical presentation of altered mental status in which the patient was found to have PI with contemporaneous HPVG. These findings have been reported to have a high mortality rate. Our patient rapidly deteriorated during their hospital course, expiring shortly after being deemed a poor surgical candidate due to their severe co-morbidity burden. Through this case, we review evidence supporting the management of patients with PI and concurrent HPVG from an extensive review of available literature. While PI is a non-specific finding and commonly a source of diagnostic confusion, a better understanding of its natural course and potentially unorthodox sequela may afford more directed and crucial care for critically ill patients, in which time is often a precious commodity.
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Affiliation(s)
- Saliha Erdem
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Suraj V Patel
- Internal Medicine, Ross University School of Medicine, Miramar, USA
| | - Dhruvil Patel
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Shivam Patel
- Biomedical Sciences, University of South Florida, Tampa, USA
| | - Shlok Patel
- Pharmaceutical Science, University of Michigan, Ann Arbor, USA
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Mehl L, Schmidt C, Weidner U, Lock G. Sonographically Detected Hepatic Portal Venous Gas - Prevalence, Causes, and Clinical Implications. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:408-413. [PMID: 35483869 DOI: 10.1055/a-1797-9986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Hepatic portal venous gas (HPVG) is a rare clinical finding, often caused by a severe underlying disease. In the literature as well as in clinical practice, HPVG is considered "signum malum" with a poor prognosis and bowel ischemia as the most common cause. Most studies are based on the results of computed tomography (CT) examinations. The aim of this retrospective study is to report on the prevalence, causes, and clinical course of HPVG in a monocentric cohort of abdominal ultrasound (US) investigations. MATERIALS AND METHODS The US database of an academic teaching hospital was searched with specific keywords (timespan 01/2000 to 12/2020). Reports, pictures, and clinical data of all cases with HPVG were re-evaluated. RESULTS Out of 134 804 US examinations, 8 HPVG cases were identified. There was a wide variety of underlying diseases, with mesenteric ischemia being seen in only 2 cases. 5 patients were discharged in stable condition, with 4 of them having undergone surgical treatment. 2 patients who had rejected further measures died, and one was lost to follow-up. DISCUSSION HPVG is a rare phenomenon in clinical US. However, ultrasonographic prevalence is comparable to the prevalence in CT studies. Underlying diseases are mostly severe, and in nearly all cases an underlying cause can be found by thorough investigation. In some cases, US may even be superior to CT scans for the detection of HPVG. Despite its rarity, every sonographer should know the typical sonographic presentation of HPVG, and appropriate images should be included in US teaching modules.
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Affiliation(s)
- Lisa Mehl
- Internal Medicine, Albertinen Hospital, Hamburg, Germany
| | | | - Ulrike Weidner
- Institute for Radiology, Albertinen Hospital, Hamburg, Germany
| | - Guntram Lock
- Internal Medicine, Albertinen Hospital, Hamburg, Germany
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Tropeano G, Di Grezia M, Puccioni C, Bianchi V, Pepe G, Fico V, Altieri G, Brisinda G. The spectrum of pneumatosis intestinalis in the adult. A surgical dilemma. World J Gastrointest Surg 2023; 15:553-565. [PMID: 37206077 PMCID: PMC10190725 DOI: 10.4240/wjgs.v15.i4.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/10/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
Pneumatosis intestinalis (PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic significance nowadays has to be cross-referenced to the nature of the underlying condition. Multiple mechanisms of pathogenesis have been debated and multiple causes have been detected during the years. All this contributes to creating a broad range of clinical and radiological presentations. The management of patients presenting PI is related to the determining cause if it is identified. Otherwise, in particular if an association with portal venous gas and/or pneumoperitoneum is present, the eventual decision between surgery and non-operative management is challenging, even for stable patients, since this clinical condition is traditionally associated to intestinal ischemia and consequently to pending clinical collapse if not treated. Considering the wide variety of origin and outcomes, PI still remains for surgeons a demanding clinical entity. The manuscript is an updated narrative review and gives some suggestions that may help make the decisional process easier, identifying patients who can benefit from surgical intervention and those who can benefit from non-operative management avoiding unnecessary procedures.
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Affiliation(s)
- Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Caterina Puccioni
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gilda Pepe
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gaia Altieri
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Topolsky A, Pantet O, Liaudet L, Sempoux C, Denys A, Knebel JF, Schmidt S. MDCT-findings in patients with non-occlusive mesenteric ischemia (NOMI): influence of vasoconstrictor agents. Eur Radiol 2023; 33:3627-3637. [PMID: 36692594 PMCID: PMC10121529 DOI: 10.1007/s00330-023-09415-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/02/2022] [Accepted: 01/01/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate the influence of vasoconstrictor agents (VCAs) on signs of vasoconstriction and bowel ischemia on MDCT detected in patients with non-occlusive mesenteric ischemia (NOMI). METHODS This 8-year single-center retrospective study consecutively included all patients with histopathologically proven NOMI who underwent MDCT ≤ 48 h prior to surgical bowel resection. Two blinded radiologists jointly reviewed each examination for signs of bowel ischemia, abdominal organ infarct, mesenteric vessel size and regularity, and ancillary vascular findings. VCA administration (length and dosage), clinical and biochemical data, risk factors, and outcomes were retrieved from patients' medical records. Subgroup comparisons were performed. RESULTS Ninety patients were included (59 males, mean age 65 years); 40 (44.4%) had received VCAs before MDCT. Overall mortality was 32% (n = 29), with no significant difference between the two groups. In patients treated with VCAs, the calibre of the superior mesenteric artery (SMA) was smaller (p = 0.032), and vasoconstriction of its branches tended to be more important (p = 0.096) than in patients not treated with VCAs. The presence and extent of bowel ischemia did not significantly correlate with VCA administration, but abdominal organ infarcts tended to be more frequent (p = 0.005) and involved more organs (p = 0.088). The VCA group had lower mean arterial pressure (p = 0.006) and lower hemoglobin levels (p < 0.001). Several biomarkers of organ failure and inflammation, differed significantly with VCA use, proving worse clinical condition. CONCLUSIONS MDCT demonstrates more severe SMA vasoconstriction and tends to show increased abdominal organ infarcts after VCA administration in NOMI patients compared to NOMI patients not treated with VCAs. KEY POINTS • In critically ill patients with NOMI, MDCT demonstrates VCA support via increased vasoconstriction of the main SMA and its branches. • VCA administration in NOMI patients tends to contribute to the development of organ infarcts, as shown on MDCT. • An important degree of vasoconstriction in NOMI patients may indicate insufficient resuscitation and, thus, help clinicians in further patient management.
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Affiliation(s)
- Antoine Topolsky
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Pantet
- Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Christine Sempoux
- Service of Clinical Pathology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Jean-François Knebel
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Hernández‐Almeida P, Vásconez‐Muñoz F, Vásconez‐Montalvo A, Sempértegui‐Moscoso R, Contreras G, Carrión‐Jaramillo E. Food protein‐induced enterocolitis syndrome with pneumatosis intestinalis in an exclusively breastfed infant: A case report and literature review. Clin Case Rep 2022; 10:e6520. [DOI: 10.1002/ccr3.6520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/25/2022] [Accepted: 10/09/2022] [Indexed: 11/25/2022] Open
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Sinz S, Schneider MA, Graber S, Alkadhi H, Rickenbacher A, Turina M. Prognostic factors in patients with acute mesenteric ischemia-novel tools for determining patient outcomes. Surg Endosc 2022; 36:8607-8618. [PMID: 36217056 PMCID: PMC9613727 DOI: 10.1007/s00464-022-09673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a devastating disease with poor prognosis. Due to the multitude of underlying factors, prediction of outcomes remains poor. We aimed to identify factors governing diagnosis and survival in AMI and develop novel prognostic tools. METHODS This monocentric retrospective study analyzed patients with suspected AMI undergoing imaging between January 2014 and December 2019. Subgroup analyses were performed for patients with confirmed AMI undergoing surgery. Nomograms were calculated based on multivariable logistic regression models. RESULTS Five hundred and thirty-nine patients underwent imaging for clinically suspected AMI, with 216 examinations showing radiological indication of AMI. Intestinal necrosis (IN) was confirmed in 125 undergoing surgery, 58 of which survived and 67 died (median 9 days after diagnosis, IQR 22). Increasing age, ASA score, pneumatosis intestinalis, and dilated bowel loops were significantly associated with presence of IN upon radiological suspicion. In contrast, decreased pH, elevated creatinine, radiological atherosclerosis, vascular occlusion (versus non-occlusive AMI), and colonic affection (compared to small bowel ischemia only) were associated with impaired survival in patients undergoing surgery. Based on the identified factors, we developed two nomograms to aid in prediction of IN upon radiological suspicion (C-Index = 0.726) and survival in patients undergoing surgery for IN (C-Index = 0.791). CONCLUSION As AMI remains a condition with high mortality, we identified factors predicting occurrence of IN with suspected AMI and survival when undergoing surgery for IN. We provide two new tools, which combine these parameters and might prove helpful in treatment of patients with AMI.
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Affiliation(s)
- Stefanie Sinz
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Marcel A Schneider
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Simon Graber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Andreas Rickenbacher
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
- Section of Colorectal Surgery, Department of Surgery, University Hospital of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Orts‐Porcar M, Ororbia A, Fina C, Herrería‐Bustillo VJ, Gómez‐Martín N, Barreiro‐Vázquez JD, González‐Rellán S, Anselmi C. Oesophageal pneumatosis: computed tomographic characteristics in three dogs (2018–2021). Vet Med Sci 2022; 8:2382-2389. [DOI: 10.1002/vms3.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | | | | | - Noemi Gómez‐Martín
- Hospital Veterinario Universidad Católica de Valencia, Valencia, Comunidad Valenciana Spain
| | - José Daniel Barreiro‐Vázquez
- Hospital Veterinario Universitario Rof Codina Facultade de Veterinaria, Universidade de Santiago de Compostela Lugo Galicia Spain
| | - Sonia González‐Rellán
- Departamento de Anatomía Produción Animal e Ciencias Clínicas Veterinarias Facultade de Veterinaria, Universidade de Santiago de Compostela Lugo Galicia Spain
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Chihab M, Qadabashi K, Abbas H, Attar M, Aljaber A, Alabd M, Ayoub K. Acute abdomen with gastric volvulus revealing an underlying pneumatosis cystoides intestinalis: a case report. BMC Surg 2022; 22:267. [PMID: 35820895 PMCID: PMC9277939 DOI: 10.1186/s12893-022-01717-6] [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] [Received: 01/12/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Pneumatosis intestinalis is an abnormal presence of free air outside the lumen of the intestines in many shapes. It is classified based on its etiology to primary or secondary, it affects adults as well as infants and can involve any part of the GI tract. Case presentation We report a case of a 55-year-old man with a past medical history of a surgically repaired perforated duodenal ulcer who presented with an acute abdominal pain, Flatulence and constipation. On examination of the abdomen; severe distension, tenderness and tympanicity on percussion were noted. An erect CXR was performed and showed bilateral sub-diaphragmatic air levels. We performed an abdominal Paracentesis under the right subcostal margin which led to evacuation of large amounts of air. Next, an investigational laparotomy showed that the reason was a gastric volvulus associated with an anterior and posterior gastric wall lacerations. The suitable surgical repair approach was taken, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) was extended along large length of the intestines in many shapes and without any symptoms or signs. Conclusions Pneumatosis cystoides intestinalis has been reported continuously in relation to peptic ulcer disease (PUD). We aim to report a new association of a gastric volvulus and PCI secondary to pyloric stenosis caused by a duodenal ulcer; which we believe can aid in the diagnosing of dangerous complications, of a rare disease.
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Affiliation(s)
- Mtanyous Chihab
- Department of Internal Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Khaled Qadabashi
- Department of Internal Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria.
| | - Huda Abbas
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Maysam Attar
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ahmad Aljaber
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Maden Alabd
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Kusay Ayoub
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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Graber SD, Sinz S, Turina M, Alkadhi H. Pneumatosis intestinalis in abdominal CT: predictors of short-term mortality in patients with clinical suspicion of mesenteric ischemia. Abdom Radiol (NY) 2022; 47:1625-1635. [PMID: 35050403 PMCID: PMC9038897 DOI: 10.1007/s00261-022-03410-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
Abstract
Purpose Pneumatosis intestinalis (PI) in the bowel wall demonstrated in computed tomography (CT) of the abdomen is unspecific and its prognostic relevance remains poorly understood. The purpose of this study was to identify predictors of short-term mortality in patients with suspected mesenteric ischemia who were referred to abdominal CT and showed PI. Methods In this retrospective, IRB-approved, single-centre study, CT scans and electronic medical records of 540 patients who were referred to abdominal CT with clinical suspicion of mesenteric ischemia were analysed. 109/540 (20%) patients (median age 66 years, 39 females) showed PI. CT findings were correlated with surgical and pathology reports (if available), with clinical and laboratory findings, and with patient history. Short-term outcome was defined as survival within 30 days after CT. Results PI was found in the stomach (n = 6), small bowel (n = 65), and colon (n = 85). Further gas was found in mesenteric (n = 54), portal (n = 19) and intrahepatic veins (n = 36). Multivariate analysis revealed that PI in the colon [odds ratio (OR) 2.86], elevated blood AST levels (OR 3.00), and presence of perfusion inhomogeneities in other abdominal organs (OR 3.38) were independent predictors of short-term mortality. Surgery had a positive effect on mortality (88% lower likelihood of mortality), similar to the presence of abdominal pain (65% lower likelihood). Conclusions Our study suggests that in patients referred for abdominal CT with clinical suspicion of mesenteric ischemia, location of PI in the colon, elevation of blood AST, and presence of perfusion inhomogeneities in parenchymatous organs are predictors of short-term mortality. Graphical abstract ![]()
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Affiliation(s)
- Simon D Graber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zürich, Switzerland
| | - Stefanie Sinz
- Department of Visceral Surgery, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Matthias Turina
- Department of Visceral Surgery, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zürich, Switzerland.
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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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The added value of multidetector CT in the diagnosis of gastrointestinal causes of acute abdomen in geriatrics. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Due to changes in the gastrointestinal system in geriatric people, there are higher rates of atypical presentations of common disorders. In order to decrease the mortality rate, an efficient and correct diagnosis should be given for these patients. The aim of this study was to assess the role of MDCT in evaluating gastrointestinal tract-related acute abdominal pain in geriatric patients.
Results
Among fifty geriatric patients presented clinically with acute abdominal pain of gastrointestinal origin from November 2019 to September 2020, mean age was 70.2 ± 5.6 years ranging from 65 to 86 years. Majority were female, (thirty patients, 60%). Gastric causes (16%): obstruction (62.5%) and perforation (37.5%); and intestinal causes (84%): obstruction (71.4%), inflammatory (28.6%), perforation (23.8%), vascular (11.9%), and others (2.4%) were the frequent causes of acute abdominal pain in the studied patients. MDCT had a very high sensitivity of 98% (95% CI) as well as its PPV (95% CI) was 100% in the evaluation of gastrointestinal-related acute abdominal pain.
Conclusion
MDCT is a reliable diagnostic imaging modality for geriatric patients presented with acute abdominal pain suggested to be of gastrointestinal origin with a very high sensitivity in diagnosing the causative pathological conditions. MDCT can efficiently differentiate between obstructive, inflammatory, perforated, and ischemic bowel disorders.
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14
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González-Palacio CL, Venegas-Yáñez CE, Enríquez-Sánchez LB, Carrillo-Gorena MJ, Aguirre-Baca A. Finding of gastric pneumatosis on a computed tomography scan as a sign of gastric ischemia secondary to probable thrombosis in a patient with chronic kidney disease: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:443-445. [PMID: 34391701 DOI: 10.1016/j.rgmxen.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/10/2020] [Indexed: 10/20/2022]
Affiliation(s)
| | - C E Venegas-Yáñez
- Departamento de Cirugía General, Hospital Central del Estado, Chihuahua, Mexico
| | | | | | - A Aguirre-Baca
- Universidad Autónoma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Chihuahua, Mexico
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15
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Della Seta M, Kloeckner R, Pinto Dos Santos D, Walter-Rittel TC, Hahn F, Henze J, Gropp A, Pratschke J, Hamm B, Geisel D, Auer TA. Pneumatosis intestinalis and porto-mesenteric venous gas: a multicenter study. BMC Med Imaging 2021; 21:129. [PMID: 34429069 PMCID: PMC8383372 DOI: 10.1186/s12880-021-00651-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine. METHODS A total of 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis). RESULTS Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p < 0.001). In the entire patient group, 53.5% (155/290) were treated surgically with a 90d mortality of 58.8% (91/155) in this latter group, while 90d mortality was 51.1% (69/135) in patients treated conservatively. In the patients who survived > 90d treated conservatively (24.9% of the entire collective; 72/290) PMVG/PI was defined as "benign"/reversible. PMVG, COPD, sepsis and a low platelet count were found to correlate with a worse prognosis helping to identify patients who might not profit from surgery, in this context our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV. CONCLUSION Although PI is associated with high morbidity and mortality, "benign causes" are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.
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Affiliation(s)
- Marta Della Seta
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Roman Kloeckner
- Department for Radiology, University Hospital Mainz, Mainz, Germany
| | | | - Thula Cannon Walter-Rittel
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Hahn
- Department for Radiology, University Hospital Mainz, Mainz, Germany
| | - Jörn Henze
- Department for Radiology, University Hospital of Cologne, Cologne, Germany
| | - Annika Gropp
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplant Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernd Hamm
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Timo Alexander Auer
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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16
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Sivathasan S, Nagrodzki J, McGowan D. Twelve tips for interpreting abdominal CT scans. MEDICAL TEACHER 2021; 43:956-959. [PMID: 33142074 DOI: 10.1080/0142159x.2020.1839033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Abdominal computerised tomography (CT) scans are a crucial tool in the diagnosis and management of the acute abdomen. Currently, medical students are not widely and extensively trained in the interpretation of abdominal scans. AIM We aim to provide advice about interpreting abdominal CT scans. METHODS We used the critical reflection of our experiences, both in clinical practice and in teaching, alongside advice from the literature to develop these tips. RESULTS Twelve tips following the '4As, 3Bs, 2Cs and 1D' approach are presented to assist doctors and medical students with interpreting abdominal CT scans. CONCLUSION The early identification of pathology on CT scans has been demonstrated to improve patient outcomes in certain cases, while a formal radiologist's report is awaited. Following a systematic approach, such as the one we presented here, may aid trainees in looking at abdominal CT scans.
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Affiliation(s)
| | - Jakub Nagrodzki
- Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - David McGowan
- Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
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17
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Esposito AA, Zannoni S, Castoldi L, Giannitto C, Avola E, Casiraghi E, Catalano O, Carrafiello G. Pseudo-pneumatosis of the gastrointestinal tract: its incidence and the accuracy of a checklist supported by artificial intelligence (AI) techniques to reduce the misinterpretation of pneumatosis. Emerg Radiol 2021; 28:911-919. [PMID: 34021845 DOI: 10.1007/s10140-021-01932-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/07/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess the incidence of erroneous diagnosis of pneumatosis (pseudo-pneumatosis) in patients who underwent an emergency abdominal CT and to verify the performance of imaging features, supported by artificial intelligence (AI) techniques, to reduce this misinterpretation. METHODS We selected 71 radiological reports where the presence of pneumatosis was considered definitive or suspected. Surgical findings, clinical outcomes, and reevaluation of the CT scans were used to assess the correct diagnosis of pneumatosis. We identified four imaging signs from literature, to differentiate pneumatosis from pseudo-pneumatosis: gas location, dissecting gas in the bowel wall, a circumferential gas pattern, and intramural gas beyond a gas-fluid/faecal level. Two radiologists reevaluated in consensus all the CT scans, assessing the four above-mentioned variables. Variable discriminative importance was assessed using the Fisher exact test. Accurate and statistically significant variables (p-value < 0.05, accuracy > 75%) were pooled using boosted Random Forests (RFs) executed using a Leave-One-Out cross-validation (LOO cv) strategy to obtain unbiased estimates of individual variable importance by permutation analysis. After the LOO cv, the comparison of the variable importance distribution was validated by one-sided Wilcoxon test. RESULTS Twenty-seven patients proved to have pseudo-pneumatosis (error: 38%). The most significant features to diagnose pneumatosis were presence of dissecting gas in the bowel wall (accuracy: 94%), presence of intramural gas beyond a gas-fluid/faecal level (accuracy: 86%), and a circumferential gas pattern (accuracy: 78%). CONCLUSION The incidence of pseudo-pneumatosis can be high. The use of a checklist which includes three imaging signs can be useful to reduce this overestimation.
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Affiliation(s)
- Andrea Alessandro Esposito
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy.
| | - Stefania Zannoni
- Post-Graduate School in Radiodiagnostics, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Laura Castoldi
- Department of Surgical Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy
| | - Caterina Giannitto
- Department of Radiology, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Emanuele Avola
- Post-Graduate School in Radiodiagnostics, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Elena Casiraghi
- Department of Computer Science, University of Milan, Via Celoria 18, 20133, Milan, Italy
| | - Onofrio Catalano
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy
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18
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Lebert P, Ernst O, Zins M, Lanchou M, Nzamushe JR, Vermersch M. Pneumatosis intestinalis and portal venous gas in mechanical small bowel obstruction: Is it worrisome? Diagn Interv Imaging 2021; 102:545-551. [PMID: 34030989 DOI: 10.1016/j.diii.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference. MATERIALS AND METHODS Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25-93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%). RESULTS Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO. CONCLUSION PI and PVG are not specific signs of bowel necrosis in mechanical SBO.
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Affiliation(s)
- Paul Lebert
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France.
| | - Olivier Ernst
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Marc Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 75014 Paris, France
| | - Marie Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Jean-Robert Nzamushe
- Department of Emergency Surgery, Lille University Hospital, 59037 Lille Cedex, France
| | - Mathilde Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
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19
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Fujii M, Yamashita S, Tashiro J, Tanaka M, Takenaka Y, Yamasaki K, Masaki Y. Clinical characteristics of patients with pneumatosis intestinalis. ANZ J Surg 2021; 91:1826-1831. [PMID: 33825311 DOI: 10.1111/ans.16772] [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: 09/25/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several theories explaining the development of pneumatosis intestinalis (PI) have been reported, but a substantial portion of cases have been idiopathic. Additionally, predictors of bowel ischaemia in PI have not been fully investigated, while PI with bowel ischaemia has deteriorated overall outcomes of PI. METHODS Sixty-four patients diagnosed with PI (2009-2019) were allocated to two groups: with (group 1; n = 15 (23%)) and without (group 2; n = 49 (77%)) bowel ischaemia. Fourteen patients underwent emergency surgery, and bowel ischaemia was identified in nine (64%). Six patients in group 1 were diagnosed with bowel ischaemia, and were treated palliatively. On medical charts, we determined underlying conditions of PI, compared the characteristics and outcomes between the groups, and identified the predictors of bowel ischaemia. RESULTS Group 1 patients more commonly showed abdominal pain, lower base excess, higher C-reactive protein concentrations, higher white blood cell counts and higher neutrophil-to-lymphocyte ratios, and more frequent comorbid ascites, free air and hepatic portal vein gas. Of nine bowel ischaemia surgery patients, three (33%) died; all because of anastomotic leak. All except three patients in group 2, who presented with aspiration pneumonia, responded to treatment. Only one patient had an unknown cause (1/64, 1.6%), and various underlying conditions in secondary PI were confirmed. CONCLUSION Idiopathic PI may be identified rarely using current imaging and knowledge, but outcomes in PI patients with bowel ischaemia remain unsatisfactory. Earlier identification of bowel ischaemia by various specialists in accordance with predictors of bowel ischaemia could improve overall outcomes in PI patients.
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Affiliation(s)
- Manato Fujii
- Department of Surgery, Ome Municipal General Hospital, Tokyo, Japan
| | - Suguru Yamashita
- Department of Surgery, Ome Municipal General Hospital, Tokyo, Japan
| | - Jo Tashiro
- Department of Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Mayuko Tanaka
- Department of Radiology, Ome Municipal General Hospital, Tokyo, Japan
| | | | - Kazuki Yamasaki
- Department of Surgery, Ome Municipal General Hospital, Tokyo, Japan
| | - Yukiyoshi Masaki
- Department of Surgery, Ome Municipal General Hospital, Tokyo, Japan
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20
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Abstract
PURPOSE OF REVIEW To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. RECENT FINDINGS A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present. No specific biomarkers are available to detect early mucosal injury in clinical setting. Nonocclusive mesenteric ischemia presents particular challenges, as the diagnosis based on CT-findings as well as vascular management is more difficult; some recent evidence suggests a possible role of potentially treatable stenosis of superior mesenteric artery and beneficial effect of vasodilator therapy (intravenous or local intra-arterial). Medical management of AMI is supportive, including aiming of euvolemia and balanced systemic oxygen demand/delivery. Enteral nutrition should be withheld during ongoing ischemia-reperfusion injury and be started at low rate after revascularization of the (remaining) bowel is convincingly achieved. SUMMARY Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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21
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Abstract
We report the case of a 59-year old man with portomesenteric venous gas (PMVG) due to inferior mesenteric vein fistulization caused by sigmoid diverticulitis with an unusual evolution. The patient initially presented with classic symptoms of lower abdominal pain and fever. Diagnosis of uncomplicated sigmoid diverticulitis was confirmed on computed tomography (CT) for which intravenous antibiotics were initiated. Hemocultures were positive for omnisensitive Escherichia Coli, but despite adequate intravenous antibiotic therapy, episodes of bacteraemia persisted and hemocultures remained positive. Repeat CT scan demonstrated regression of inflammation without signs of abcedation or perforation consistent with clinical findings. Endocarditis was excluded with a normal transoesophageal echocardiography. Finally, positron emission tomography-computed tomography (PET-CT) suspected a colovenous fistula and the presence of PMVG. The patient was successfully treated with laparoscopic sigmoidectomy. This case report summarises the diagnostic pathway and aims for higher awareness of non-ischemic PMVG causes.
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22
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Roy J, Kang M, Stern B, Riley T, Schreibman I. Lactulose-induced pneumatosis intestinalis following colonoscopy: a case report. Clin J Gastroenterol 2021; 14:1152-1156. [PMID: 33772734 DOI: 10.1007/s12328-021-01392-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/17/2021] [Indexed: 01/13/2023]
Abstract
Pneumatosis intestinalis (PI) occurs when gas is discovered in the intestinal wall and is categorized into two types: primary PI which is idiopathic and mainly occurs in the colon, and secondary PI which occurs more often in the small bowel but has variable presentation and etiology. We report a case of a patient status post-orthotopic deceased liver transplantation complicated by a portal vein thrombus on chronic lactulose for portosystemic encephalopathy who presented due to pyelonephritis and persistent diarrhea. The patient underwent colonoscopy with random biopsies and subsequently developed acute sepsis with Escherichia coli bacteremia. The findings of PI were noted on computed tomography imaging obtained 5 days post-colonoscopy, due to persistent post-procedure abdominal pain. The patient was treated with discontinuation of lactulose, supportive care, and antibiotics for her bacteremia with resolution of her PI 3 days later. This suggests that a combination of factors may lead to the development of PI, and while some cases require emergent intervention including surgery, others may be treated conservatively. Awareness of risk factors that may precipitate PI and specific clinical predictors may help to both mitigate and manage PI appropriately.
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Affiliation(s)
- Justin Roy
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Mitchell Kang
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Benjamin Stern
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Thomas Riley
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ian Schreibman
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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23
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González-Palacio CL, Venegas-Yáñez CE, Enríquez-Sánchez LB, Carrillo-Gorena MJ, Aguirre-Baca DA. Finding of gastric pneumatosis on a computed tomography scan as a sign of gastric ischemia secondary to probable thrombosis in a patient with chronic kidney disease: A case report. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:S0375-0906(21)00001-X. [PMID: 33558120 DOI: 10.1016/j.rgmx.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/12/2020] [Accepted: 10/10/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - C E Venegas-Yáñez
- Departamento de Cirugía General, Hospital Central del Estado, Chihuahua, México
| | | | | | - D A Aguirre-Baca
- Universidad Autónoma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Chihuahua, México
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24
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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25
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Tang NSJ, Duong C. Benign free air under the diaphragm: a case of pneumatosis cystoides coli. ANZ J Surg 2020; 91:E389-E390. [PMID: 33131176 DOI: 10.1111/ans.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Cuong Duong
- Department of General Surgery, Western Hospital, Melbourne, Victoria, Australia
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26
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Auer TA, Denecke T, Fehrenbach U. Ischämie als Ursache für eine reversible Pneumatosis intestinalis. ROFO-FORTSCHR RONTG 2020; 192:961-963. [DOI: 10.1055/a-1108-1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Timo Alexander Auer
- Klinik für Radiologie, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Germany
| | - Timm Denecke
- Klinik für Diagnostische und Interventionelle Radiologie, Universiätsklinikum Leipzig, Germany
| | - Uli Fehrenbach
- Klinik für Radiologie, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Germany
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27
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Alataby H, Daniel M, Bibawy J, Diaz K, Nfonoyim J. Gastric Emphysema and Hepatic Portal Vein Gas as Complications of Noninvasive Positive Pressure Ventilation. Cureus 2020; 12:e9086. [PMID: 32789036 PMCID: PMC7417069 DOI: 10.7759/cureus.9086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Gastric emphysema (GE) in association with hepatic portal vein gas (HPVG) is a rare, benign medical condition that is very seldom caused by noninvasive positive pressure ventilation (NIPPV). This report describes a patient who developed GE along with gastric vein gas and HPVG, most likely due to multiple episodes of vomiting in combination of using bilevel positive airway pressure (BiPAP), a form of NIPPV. The patient responded to conservative treatment with intravenous fluids, pantoprazole, and the urgent cessation of BiPAP and oral intake.
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Affiliation(s)
- Harith Alataby
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Mina Daniel
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Joseph Bibawy
- Radiology, Richmond University Medical Center, Staten Island, USA
| | - Keith Diaz
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center, Staten Island, USA
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28
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Panico C, di Meo M, Tammaro N, Pirozzi REM, Cusati B. Porto-mesenteric venous gas as a sign of gastric mucosal damage remitted after surgery: a case report. Acta Radiol Open 2020; 9:2058460120911586. [PMID: 32284881 PMCID: PMC7137391 DOI: 10.1177/2058460120911586] [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] [Received: 08/05/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022] Open
Abstract
Porto-mesenteric venous gas (PMVG) is a severe sign of abdominal organs damage. Imaging diagnostic criteria allow the detection of PMVG and should be applied in the presence of severe symptoms and signs of abdominal organs damage. Our case had clinical signs of epigastric pain and abdominal tenderness and ultrasonography and computed tomography evidence of PMVG and gastric cancer. The subsequent surgery, without complications, induced PMVG to disappear and the patient to be dismissed from hospital.
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Affiliation(s)
- Camilla Panico
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli Federico II, Naples, Italy
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Camilla Panico, Università degli Studi di Napoli Federico II, via Pansini 5, Naples, 80131, Italy.
| | | | - Nicola Tammaro
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Dipartimento di Chirurgia Generale e Specialistica, Università di Napoli Federico II, Naples, Italy
| | - Raffaele EM Pirozzi
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Dipartimento di Chirurgia Generale e Specialistica, Università di Napoli “L. Vanvitelli,” Naples, Italy
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29
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Transmural Bowel Necrosis From Acute Mesenteric Ischemia and Strangulated Small-Bowel Obstruction: Distinctive CT Features. AJR Am J Roentgenol 2020; 214:90-95. [DOI: 10.2214/ajr.19.21693] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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30
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Cho YM, Behrenbruch C, Smart P. Colonic lymphoma or pneumatosis coli: should I biopsy? ANZ J Surg 2019; 90:1198-1200. [PMID: 31667907 DOI: 10.1111/ans.15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/08/2019] [Accepted: 09/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yeo Min Cho
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Corina Behrenbruch
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Philip Smart
- Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia.,Department of Surgery, Austin Health, Melbourne, Victoria, Australia.,General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Melbourne, Victoria, Australia
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31
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Gao Y, Uffenheimer M, Ashamallah M, Grimaldi G, Swaminath A, Sultan K. Presentation and outcomes among inflammatory bowel disease patients with concurrent pneumatosis intestinalis: a case series and systematic review. Intest Res 2019; 18:289-296. [PMID: 31671928 PMCID: PMC7385580 DOI: 10.5217/ir.2019.00073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/29/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Inflammatory bowel disease (IBD) involves chronic inflammation of the colon with ulcerative colitis (UC), and the colon and/or small intestine with Crohn’s disease (CD). Pneumatosis intestinalis (PI), characterized by compromise of the intestinal wall with gas-filled cysts, has rarely been reported with IBD. The presentation, best management and outcomes of PI with IBD are poorly defined. Methods We conducted a search for PI in all abdominal computed tomography (CT) reports at 2 large tertiary care hospitals from January 1, 2010 to December 31, 2017, cross referenced to ICD codes for IBD. CT and chart review was performed to confirm PI and IBD respectively. A systematic review excluding case reports was performed for PI with IBD for comparison. Results Of 5,990 patients with a CT abdomen report mentioning PI, we identified 11 cases of PI with IBD, 4 UC, 6 CD, and 1 indeterminate colitis. PI was limited to the small bowel in 5 patients, the right colon in 5, and small bowel and colonic in 1. All 3 mortalities had CD, small intestinal PI and portal/mesenteric venous gas. The systematic literature search identified 9 articles describing 58 patients with IBD and PI. These cases were mostly included in larger cohorts of PI patients without extractable data on presentation or outcomes in the IBD subpopulation. Conclusions Ours appears to be the first reporting of presentations and outcomes, outside of case reports, for those with PI and IBD. The high mortality for those with CD and PI of the small bowel appears to define a group requiring more than supportive medical care.
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Affiliation(s)
- Youran Gao
- Division of Gastroenterology, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY, USA
| | - Meka Uffenheimer
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael Ashamallah
- Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY, USA
| | - Gregory Grimaldi
- Department of Radiology, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
| | - Keith Sultan
- Division of Gastroenterology, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY, USA
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32
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González-Olivares C, Palomera-Rico A, Romera-Pintor Blanca N, Sánchez-Aldehuelo R, Figueroa-Tubío A, García de la Filia I, López-Sanromán A. Pneumatosis intestinalis in Crohn's disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:181-183. [PMID: 29880416 DOI: 10.1016/j.gastrohep.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Affiliation(s)
| | - Ana Palomera-Rico
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Rubén Sánchez-Aldehuelo
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Alexandre Figueroa-Tubío
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Irene García de la Filia
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Antonio López-Sanromán
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, España.
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33
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Smyth AI, Osmanska J, Lip S, Chong PS, Dalzell JR. AN UNUSUAL GASTROINTESTINAL COMPLICATION FOLLOWING HEART TRANSPLANTATION. THE ULSTER MEDICAL JOURNAL 2019; 88:56. [PMID: 31073250 PMCID: PMC6498450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Alison I Smyth
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK,Correspondence to: Dr Alison Smyth, E-mail:
| | - Joanna Osmanska
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK
| | - Stefanie Lip
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK
| | - Peter S Chong
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Jonathan R Dalzell
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK
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34
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Asahi Y, Suzuki T, Sawada A, Kina M, Takada J, Gotoda H, Masuko H. Pneumatosis Cystoides Intestinalis Secondary to Sunitinib Treatment for Gastrointestinal Stromal Tumor. Case Rep Gastroenterol 2018; 12:432-438. [PMID: 30186096 PMCID: PMC6120377 DOI: 10.1159/000490657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022] Open
Abstract
A 67-year-old man with liver and retroperitoneal metastases from a gastrointestinal stromal tumor arising in the jejunum had been administered oral sunitinib for 2 months. He presented to our department with right-sided lower abdominal pain. His general condition was good, with no high-grade fever, and the other vital signs were also stable. Contrast-enhanced computed tomography was promptly performed, and pneumatosis cystoides intestinalis (PCI) was detected in a wide area around the ileocecal lesion. There were no signs of acute abdomen requiring emergency surgery due to conditions such as intestinal perforation, ischemia, or obstruction. Sunitinib was discontinued and the patient was placed on nil orally with intravenous infusion. PCI resolved promptly and the patient was discharged on the 21st day after admission. PCI is a rare side effect of sunitinib with only 8 cases reported previously, which can complicate with acute abdomen or gastrointestinal perforation, in some cases. Thus, the early identification of sunitinib as the cause of PCI is important. Although PCI is a rare adverse effect of sunitinib, clinicians must be aware of it to promptly provide the correct diagnosis and treatment.
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Affiliation(s)
- Yoh Asahi
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Takuto Suzuki
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Akiufumi Sawada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Masaya Kina
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Joji Takada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Hiroko Gotoda
- Department of Clinical Pathology, Nikko Memorial Hospital, Muroran, Japan
| | - Hiroyuki Masuko
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
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35
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Tamura H, Kanda T, Chida T, Kameyama H, Tateishi U, Wakai T, Naito M. Prolonged postoperative ileus in a patient with primary pneumatosis cystoides intestinalis: a case report. Surg Case Rep 2018. [PMID: 29542027 PMCID: PMC5852123 DOI: 10.1186/s40792-018-0431-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gas-filled cysts in the intestinal wall and is associated with various comorbidities. We report herein a case of intractable paralytic ileus caused by primary PCI. Case presentation A 73-year-old man visited out hospital complaining of abdominal pain and vomiting. He had been hospitalized twice for intestinal obstruction in the past 2 months. Based on his history of appendectomy, mechanical bowel obstruction caused by adhesion was diagnosed, and the patient underwent surgery. However, laparotomy revealed small bowel dilatation despite the absence of obstruction or stenosis. Multiple nodules were found in the wall of the dilated bowel loops. The dilated jejunum was excised. Histological examination revealed that the nodules were small gas-filled cysts, suggesting PCI. We made a diagnosis of ileus with underlying PCI and managed the patient conservatively. A large amount of nasogastric tube drainage continued for a long period postoperatively. The patient underwent relaparotomy 35 days after the first operation. The upper jejunum was markedly dilated, although no mechanical stenosis was found. The atonic, dilated jejunum was excised and the ileal stump was anastomosed to the duodenum in a double tract fashion. The patient underwent hyperbaric oxygen therapy because the ileus persisted postoperatively. His condition gradually improved and he was discharged 53 days after the second operation. Conclusions Non-operative treatment is recommended for primary PCI of unknown etiology. Surgeons should be mindful of the possibility of primary PCI when considering surgical intervention for patients with bowel obstruction.
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Affiliation(s)
- Hiroshi Tamura
- Department of Surgery, Sanjo General Hospital, Tsukanome, Sanjo, 955-0055, Japan.,Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Tatsuo Kanda
- Department of Surgery, Sanjo General Hospital, Tsukanome, Sanjo, 955-0055, Japan.
| | - Tadasu Chida
- Department of Surgery, Sanjo General Hospital, Tsukanome, Sanjo, 955-0055, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Ukihide Tateishi
- Department of Radiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Makoto Naito
- Department of Pathology, Niigata Medical Center, Kobari, Nishi-ku, Niigata, 950-2022, Japan
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36
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Copin P, Zins M, Nuzzo A, Purcell Y, Beranger-Gibert S, Maggiori L, Corcos O, Vilgrain V, Ronot M. Acute mesenteric ischemia: A critical role for the radiologist. Diagn Interv Imaging 2018; 99:123-134. [DOI: 10.1016/j.diii.2018.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 12/13/2022]
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37
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Tewari SO, Wolfe AR, Seguritan R, Faroqui R, Meshreki M. Esophageal pneumatosis in the setting of small bowel ileus with acute resolution after nasogastric tube decompression. Radiol Case Rep 2017; 12:479-482. [PMID: 28828106 PMCID: PMC5551920 DOI: 10.1016/j.radcr.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 02/20/2017] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
Esophageal pneumatosis is a rare condition with diverse potential etiologies including traumatic, mechanical, ischemic, obstructive respiratory, autoimmune, immunodeficient, and infectious causes. Here, we present a case of esophageal pneumatosis in the setting of upper gastrointestinal and small bowel ileus, diagnosed on computed tomography (CT), with acute resolution after nasogastric tube decompression. A patient presented to the emergency department with epigastric discomfort. CT of the abdomen/pelvis demonstrated intramural air in the mid-to-distal esophagus, consistent with esophageal pneumatosis, and diffuse dilatation of the visualized esophagus, stomach, and small bowel, consistent with an ileus. Patient was managed with nasogastric tube decompression and bowel rest. Subsequent esophagram did not demonstrate any evidence of perforation and a repeat CT of the abdomen/pelvis, performed 11 hours after initial diagnostic CT, demonstrated interval resolution of patient's esophageal pneumatosis, and improvement of patient's ileus.
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Affiliation(s)
- Sanjit O Tewari
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Allen R Wolfe
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Richard Seguritan
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Raihan Faroqui
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
| | - Michael Meshreki
- Department of Radiology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
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