1
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Fleck M, Zein L, Doussot A, Turco C, Lakkis Z, Simon G, Busse-Coté A, Piton G, Delabrousse E, Calame P. CT evaluation of bowel wall enhancement in pneumatosis intestinalis: preventing non-therapeutic laparotomies. Abdom Radiol (NY) 2024:10.1007/s00261-024-04450-1. [PMID: 38954000 DOI: 10.1007/s00261-024-04450-1] [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: 04/02/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To evaluate the diagnostic performance of bowel wall enhancement for diagnosing concomitant bowel ischemia in patients with parietal pneumatosis (PI) diagnosed at abdominal CT. MATERIALS AND METHODS From January 1, 2012 to December 31, 2021, 226 consecutive patients who presented with PI on abdominal CT from any bowel segment were included. Variables at the time of the CT were retrospectively extracted from medical charts. CT examinations were blindly analyzed by two independent radiologists. The third reader classified all disagreement of bowel enhancement in three categories: (1) normal bowel enhancement; (2) doubtful bowel wall enhancement; (3) absent bowel wall enhancement. Multivariable logistic regression analysis was performed. Concomitant bowel ischemia was defined as requirement of bowel resection specifically due to ischemic lesion in operated patients and death from bowel ischemia in non-operated patients. RESULTS Overall, 78/226 (35%) patients had PI associated with concomitant bowel ischemia. At multivariate analysis, Only absence or doubtful bowel wall enhancement was associated with concomitant bowel ischemia (OR = 167.73 95%CI [23.39-4349.81], P < 0,001) and acute mesenteric ischemia associated with PP (OR = 67.94; 95%CI [5.18-3262.36], P < 0.009). Among the 82 patients who underwent a laparotomy for suspected bowel ischemia, rate of non-therapeutic laparotomy increased from 15/59 (25%), 2/6 (50%) and 16/17 (94%) when bowel wall enhancement was absent, doubtful and normal respectively. CONCLUSION Absence of enhancement of the bowel wall is the primary feature associated with concomitant bowel ischemia. It should be carefully assessed when PI is detected to avoid non-therapeutic laparotomy.
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Affiliation(s)
- Martin Fleck
- Department of Radiology, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Lisa Zein
- Department of Radiology, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Alexandre Doussot
- Department of Digestive Surgery, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Celia Turco
- Department of Digestive Surgery, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Gabriel Simon
- Department of Radiology, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Andreas Busse-Coté
- Department of Radiology, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Gael Piton
- Medical Intensive Care Unit, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France
| | - Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté and CHU Besançon, 25030, Besançon, France.
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
- Service de Radiologie, CHRU Besançon, Hôpital Jean Minjoz, 3 Boulevard Fleming, 25030, Besançon, France.
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Chinello M, Arnone OC, Artusa S, Mazzuca G, Bonetti E, Vitale V, Zaccaron A, Raniero D, Cesaro S. Pneumatosis Cystoides Intestinalis with Fatal Air Embolism after Minor Blunt Abdominal Trauma in a 6-Year-Old Girl Undergoing Hematopoietic Stem Cell Trasplant: Case Report and Review of Literature. Mediterr J Hematol Infect Dis 2024; 16:e2024028. [PMID: 38468831 PMCID: PMC10927201 DOI: 10.4084/mjhid.2024.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Matteo Chinello
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Olivia Chapin Arnone
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Silvia Artusa
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Giorgia Mazzuca
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Elisa Bonetti
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Virginia Vitale
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Ada Zaccaron
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Dario Raniero
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
| | - Simone Cesaro
- Azienda Ospedaliera Universitaria Integrata Verona. Piazzale Aristide Stefani, 1. 37126 Verona. Italy
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Atri S, Hammami M, Sebai A, Zaiem A, Laabidi S, Kacem M. Incidental pneumoperitoneum due to pneumatosis intestinalis: A rare case of benign pneumoperitoneum. Int J Surg Case Rep 2024; 116:109363. [PMID: 38340627 PMCID: PMC10943630 DOI: 10.1016/j.ijscr.2024.109363] [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: 12/12/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a rare but significant gastrointestinal condition. It may be associated with underlying gastrointestinal disorders or detected incidentally, posing diagnostic challenges. This article emphasizes the importance of recognizing and managing this condition conservatively when appropriate. CASE PRESENTATION A previously healthy 40-year-old Caucasian female patient presented with left lumbar fossa pain, initially suggestive of renal colic. Physical examination revealed stable vital signs and a soft abdomen. Laboratory tests showed no signs of inflammation or renal abnormalities. Abdominal CT scan ruled out urinary lithiasis but identified pericolonic pneumoperitoneum on the left side. Due to the absence of peritonitis signs, surgical intervention was deferred. Over 72 h of close monitoring, the patient remained stable without clinical deterioration. Subsequent CT scans confirmed pneumatosis intestinalis. The patient remained asymptomatic and underwent a confirming colonoscopy. CLINICAL DISCUSSION Pneumatosis intestinalis can manifest with varying severity and is often linked to underlying gastrointestinal conditions. It can mimic life-threatening conditions like bowel perforation, necessitating careful differentiation. Non-surgical pneumoperitoneum, exemplified in this case, may result from benign causes like PI, warranting meticulous evaluation to prevent unnecessary surgery. CONCLUSION This case highlights the need to recognize and manage asymptomatic PI. A multidisciplinary approach and CT imaging play pivotal roles in ensuring optimal patient outcomes. Vigilance among healthcare professionals is essential to consider PI in asymptomatic patients, mitigating the risk of undue surgical interventions, and facilitating timely diagnosis and intervention when necessary.
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Affiliation(s)
- Souhaib Atri
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
| | - Mahdi Hammami
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia.
| | - Amine Sebai
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
| | - Aida Zaiem
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
| | - Sarra Laabidi
- Department of Gastroenterology, Hopital la Rabta, Tunis, Tunisia
| | - Montassar Kacem
- Department of General Surgery, Hopital la Rabta, Tunis, Tunisia
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4
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Strahm R, Pratsinis A, Jochum AK, De Lorenzi D. Idiopathic Pneumatosis cystoides intestinalis of the small bowel with pneumoperitoneum and consecutive small bowel mesenteric torsion. A case report. Int J Surg Case Rep 2024; 115:109220. [PMID: 38194864 PMCID: PMC10819719 DOI: 10.1016/j.ijscr.2024.109220] [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: 11/22/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cyst-like structures in the submucosa and subserosa of the small or large intestine and in some cases accompanied by pneumoperitoneum. PCI is commonly considered a benign condition as opposed to pneumatosis intestinalis in life-threatening conditions such as mesenteric ischemia. Only a minority of cases of PCI are assumed to be primary or idiopathic with the majority being caused by a variety of underlying conditions. Symptoms of PCI are non-specific or may be absent altogether. Provided that there is no suspicion of an underlying life-threatening disease, PCI can be treated non-operatively. CASE PRESENTATION We present the case of a 71-year-old patient with pneumatosis intestinalis with free intraperitoneal gas known for three years. Due to self-limiting symptoms and lack of evidence of a life-threatening underlying disease, no specific therapy had been carried out so far. No underlying diseases could be found. Because of recurrent worsening abdominal pain and newly diagnosed partial small bowel obstruction with radiological signs of mesenteric torsion, resection of the affected small bowel was successfully performed. DISCUSSION Non-surgical management of PCI is possible provided that life-threatening causes of pneumatosis have been ruled out. Bowel obstruction is a rare complication of PCI which requires surgical treatment. CONCLUSION Our case report illustrates that symptoms of PCI may worsen over time, and that complications requiring surgical intervention may occur. We recommend regular monitoring of patients who are primarily treated non-operatively.
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Affiliation(s)
- Raphael Strahm
- Department of General and Visceral Surgery, Cantonal Hospital Grabs, Grabs, Switzerland.
| | - Antonia Pratsinis
- Department of General and Visceral Surgery, Cantonal Hospital Grabs, Grabs, Switzerland
| | - Ann-Kristin Jochum
- Institute for Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Diego De Lorenzi
- Department of General and Visceral Surgery, Cantonal Hospital Grabs, Grabs, Switzerland
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5
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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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6
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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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7
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Zhang T, Cao M, Zhao B, Pan C, Lin L, Tang C, Zhao Z, Duan J, Wang L, Liang J. Pneumatosis intestinalis post steroid use in a patient with immune-related adverse events: Case report, literature review and FAERS analysis. Front Pharmacol 2023; 14:1133551. [PMID: 36998618 PMCID: PMC10043198 DOI: 10.3389/fphar.2023.1133551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: The accurate diagnosis of pneumatosis intestinalis (PI) is increasing despite patients’ limited identification of etiologic factors. Recently a patient with lung squamous carcinoma who developed pneumatosis intestinalis following methylprednisolone administration for immune-related adverse events was treated at our hospital. Subsequent a literature review and an analysis of the FDA Adverse Event Reporting System (FAERS) database enabled the identification of additional cases of pneumatosis intestinalis.Methods: A literature review of the MEDLINE/PubMed and Web of Science Core Collection databases using standard pneumatosis intestinalis search terms to identify published cases of immune checkpoint inhibitors (ICIs) or steroids causing pneumatosis intestinalis were performed. A separate retrospective pharmacovigilance study of FAERS enabled the extraction of unpublished cases of pneumatosis intestinalis between the first quarter of 2005 and the third quarter of 2022. Disproportionality and Bayesian analyses were performed to identify signal detection in reported odds ratios, proportional reporting ratios, information components, and empirical Bayesian geometric means.Results: Ten case reports of steroid-related pneumatosis intestinalis were retrieved from six published studies. The implicated drug therapies included pre-treatment with steroids before chemotherapy, combination therapy with cytotoxic agents and steroids, and monotherapy with steroids. In the FAERS pharmacovigilance study, 1,272 cases of immune checkpoint inhibitors or steroid-related pneumatosis intestinalis were incidentally reported. The signal detected in five kinds of immune checkpoint inhibitors and six kinds of steroids implied a positive correlation between the drugs and adverse events.Conclusion: Steroids might be the etiologic factors in the current case of pneumatosis intestinalis. Reports supporting the role of steroids in suspected cases of pneumatosis intestinalis can be found in literature databases and the FAERS database. Even so, as documented in FAERS, immune checkpoint inhibitors-induced pneumatosis intestinalis should not be excluded.
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Affiliation(s)
- Tingting Zhang
- Department of Clinical Oncology, Peking University International Hospital, Beijing, China
| | - Mingnan Cao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bin Zhao
- Department of Pharmacy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Pan
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Lin
- Department of Clinical Oncology, Peking University International Hospital, Beijing, China
| | - Chuanhao Tang
- Department of Clinical Oncology, Peking University International Hospital, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingli Duan
- Department of Pharmacy, Peking University International Hospital, Beijing, China
- Clinical Trial Center, Peking University International Hospital, Beijing, China
| | - Li Wang
- Clinical Trial Center, Peking University International Hospital, Beijing, China
- *Correspondence: Li Wang, ; Jun Liang,
| | - Jun Liang
- Department of Clinical Oncology, Peking University International Hospital, Beijing, China
- *Correspondence: Li Wang, ; Jun Liang,
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8
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Miller B, Taj S, Pannu VS, Tavakolian K, Joseph L, Hossain MA. Ominous Sign of Pneumatosis Intestinalis With Portal Venous Gas. Cureus 2023; 15:e35605. [PMID: 37007392 PMCID: PMC10063244 DOI: 10.7759/cureus.35605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
The presence of gas and free air in the extraluminal space of the intestines is known as pneumatosis intestinalis (PI). There are many different causes of this finding, including gastrointestinal, pulmonary, autoimmune, and many more. It is often difficult to differentiate the etiology and clinical importance of the radiographic evidence on pneumatosis intestinalis due to the unclear pathophysiology causing the disease. To complicate things further, the ominous sign of portal venous gas poses the question of whether surgical intervention is needed. We report two cases both with clinical and radiographic evidence of secondary pneumatosis intestinalis with an associated sinister finding of portal venous gas. The cases differ by urgent surgical intervention versus observation before surgery. In this case series, we emphasize the importance of recognizing the radiographic finding and stress the need for further research to standardize a plan of care, including indications for surgery. We encourage more cases like this to be reported to aid in diagnosing and treating this condition early on with the aim of improving the mortality associated with it.
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Furtado T, Domingues P, Piedade A, Parreira L, Natário A. A Rare and Severe Cause of Abdominal Pain in a Hemodialysis Patient. Cureus 2022; 14:e30800. [DOI: 10.7759/cureus.30800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
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10
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Hisanaga E, Sano T, Kumakura Y, Yokoyama Y, Nakajima I, Takagi H. Case of pneumatosis cystoides intestinalis with intra‐abdominal free air developed during treatment with voglibose. JGH Open 2022; 6:643-646. [PMID: 36091325 PMCID: PMC9446400 DOI: 10.1002/jgh3.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Etsuko Hisanaga
- Department of Internal Medicine Kusunoki Hospital Fujioka Japan
| | - Takaaki Sano
- Department of Diagnostic Pathology, Graduate School of Medicine Gunma University Maebashi Japan
| | - Yuji Kumakura
- Department of Surgery Public Fujioka General Hospital Fujioka Japan
| | - Yozo Yokoyama
- Department of Internal Medicine Kusunoki Hospital Fujioka Japan
| | - Isao Nakajima
- Department of Radiology Kusunoki Hospital Fujioka Japan
| | - Hitoshi Takagi
- Department of Internal Medicine Kusunoki Hospital Fujioka Japan
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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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12
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Yang L, Zhong X, Yang H, Wu Q, Gong Y, Wang B. Pneumatosis cystoides intestinalis associated with etoposide in hematological malignancies: a case report and a literature review. BMC Gastroenterol 2022; 22:150. [PMID: 35346061 PMCID: PMC8959780 DOI: 10.1186/s12876-022-02219-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/16/2022] [Indexed: 12/17/2022] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of air collection within the subserosa and/or submucosa of the gastrointestinal wall. Due to the lack of specific symptoms, PCI is likely to be misdiagnosed or missed without the use of imaging techniques or gastrointestinal endoscopy. Here, we report a patient who complained of abdominal distention and constipation after chemotherapy for hematological malignancies, and was diagnosed with secondary PCI via computed tomography (CT) and exploratory laparotomy. Pneumoperitoneum was no longer observed after two weeks of conservative treatments. Notably, the possibility of intra-abdominal pressure (IAP) as a predictor for surgical intervention was proposed. Furthermore, we conducted a literature review on PCI after chemotherapy in hematological malignancies to raise awareness of etoposide-related PCI, while whether PCI could be identified as an adverse event of etoposide requires more evidence.
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13
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Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review. Cancers (Basel) 2022; 14:cancers14071666. [PMID: 35406436 PMCID: PMC8996919 DOI: 10.3390/cancers14071666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Anticancer treatments commonly cause adverse events (AE). Among others, pneumatosis intestinalis (PI) is reported to be infrequent, though it can lead to severe consequences. The aim of our systematic review was to investigate the concurrency of PI and oncological therapy exposure; moreover, we defined the characteristics of patients and the primarily involved tumor types. We analyzed 88 different episodes of PI. The median time of onset was 6 weeks and oncological patients with respiratory system cancers and those treated with targeted therapies appeared be at higher risk. Symptoms were frequently mild to absent; nevertheless, life-threatening complications were reported. Therefore, this AE, although uncommon, should be considered in the case of specific symptoms. Potential pharmacological mechanisms of anticancer drugs in inducing PI are also discussed. Abstract Pneumatosis intestinalis (PI) is a rare condition due to the presence of gas within the bowel wall; it is mainly caused by endoscopic procedures, infections and other gastrointestinal diseases. Oncological therapies have been reported to be a cause of PI as well, but their role is not clearly defined. This systematic review investigates the concurrency of PI and antitumor therapy in cancer patients, considering both solid tumors and onco-hematological ones. We performed a literature review of PubMed, Embase and the Web of Science up to September 2021 according to the PRISMA guidelines. A total of 62 papers reporting 88 different episodes were included. PI was mainly reported with targeted therapies (sunitinib and bevacizumab above all) within the first 12 weeks of treatment. This adverse event mostly occurred in the metastatic setting, but in 10 cases, it also occurred also in the neoadjuvant and adjuvant setting. PI was mostly localized in the large intestine, being fatal in 11 cases, while in the remaining cases, symptoms were usually mild, or even absent. A significant risk of PI reoccurrence after drug reintroduction was also reported (6/18 patients), with no fatal outcomes. Potential pharmacological mechanisms underlying PI pathogenesis are also discussed. In conclusion, although uncommonly, PI can occur during oncological therapies and may lead to life-threatening complications; therefore, consideration of its occurrence among other adverse events is warranted in the presence of clinical suspicion.
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Tasha T, Dutta P, Atiquzzaman B. Pneumatosis Intestinalis in a Patient With Asthma: A Case Report. Cureus 2022; 14:e22116. [PMID: 35308724 PMCID: PMC8918300 DOI: 10.7759/cureus.22116] [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] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
Pneumatosis intestinalis (PI) is a rare condition marked by gas-filled cysts in the submucosa and subserosa of the intestine. It can be idiopathic or linked to several illnesses, including gastrointestinal, pulmonary, collagen vascular disease, organ transplantation, and immunodeficiency. Herein we present a relatively rare case of PI in a 74-year-old man with a childhood history of asthma, which was found during routine colonoscopy.
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15
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Zhang Q, Niu X, Wang C, He Q, Xiang J. Pneumatosis cystoides intestinalis: A case report. Medicine (Baltimore) 2022; 101:e28588. [PMID: 35060523 PMCID: PMC8772708 DOI: 10.1097/md.0000000000028588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/27/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts in the intestinal wall, and can be caused by many conditions. PATIENT CONCERNS We reported a-69-year-old man with a long history of chronic obstructive pulmonary disease was admitted to the gastroenterology department because of alternating bowel movement and intermittent bloody stool. DIAGNOSES Colonoscopy revealed multiple nodular protuberances covered with normal-looking mucosa in the ascending and proximal transverse colon. Abdominal computed tomography scan and endoscopic ultrasound revealed multiple gas-filled cystic lesions in the submucosa. The diagnosis of PCI was confirmed by cyst collapse after puncturing with a fine needle. INTERVENTIONS AND OUTCOMES Considering that the patient had no peritonitis or other complications, conservative approaches, including oxygen inhalation and oral probiotics, were used. The patient was transferred to the anorectal department after 5days of clinical observation in good condition to further treat hemorrhoids. LESSONS PCI is a rare condition that may be secondary to many other diseases. Because of its atypical clinical manifestations, it can be misdiagnosed as other diseases, such as polyps, inflammatory bowel disease, and even cancer. The diagnosis of PCI depends on computed tomography, colonoscopy, and endoscopic ultrasonography. Fine-needle aspiration may be helpful in the diagnosis and treatment of PCI.
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Affiliation(s)
- Qiuyu Zhang
- Department of Gastroenterology, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Xiangke Niu
- Department of Radiology, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Cong Wang
- Department of Gastroenterology, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Qiang He
- Department of Gastroenterology, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Junying Xiang
- Department of Gastroenterology, Affiliated Hospital & Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
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16
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Son D, Inoue K, Lee Y, Kamimoto M, Imaoka S, Yamamoto S, Hamada T, Taniguchi S, Koda M. Anorexia in a hemodialysis patient due to pneumatosis intestinalis: A case report. J Gen Fam Med 2022; 23:41-43. [PMID: 35004110 PMCID: PMC8721326 DOI: 10.1002/jgf2.470] [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: 03/30/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022] Open
Abstract
We report a case of pneumatosis intestinalis (PI) in a hemodialysis patient who presented with anorexia and nausea. Anorexia with postprandial nausea can be caused by gastrointestinal diseases, with one of the rare causes being PI. PI may occur in hemodialysis patients, but it is rarely reported. We experienced a case of benign PI in a hemodialysis patient, for whom the conservative treatment with antibiotics improved the patient's clinical symptoms. In patients with PI, it is important to rule out potentially life-threatening complications, such as the presence of hepatic intraportal gas on CT scan.
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Affiliation(s)
- Daisuke Son
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Kazuoki Inoue
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Young Lee
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Minako Kamimoto
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Shintaro Imaoka
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Shiori Yamamoto
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Toshihiro Hamada
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
| | - Shin‐ichi Taniguchi
- Department of Community‐based Family MedicineFaculty of MedicineTottori UniversityYonagoJapan
- Department of General MedicineHino HospitalHino‐gunJapan
| | - Masahiko Koda
- Department of Internal MedicineHino HospitalHino‐gunJapan
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17
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Miratashi Yazdi SA, Chinisaz F, Mohammadi L, Najjari K, Zabihi Mahmoudabadi H. Intestinal volvulus secondary to pneumatosis intestinalis: A case report. Int J Surg Case Rep 2021; 88:106515. [PMID: 34695667 PMCID: PMC8554248 DOI: 10.1016/j.ijscr.2021.106515] [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: 09/30/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Pneumatosis intestinalis (PI) is a rare but important medical condition that is defined as a collection of individual gas cysts in the submucosa and subserosa of the intestine. PI can be primary or secondary; however, this condition is secondary to underlying diseases most of the time. CASE PRESENTATION This article presents a 30-year-old man as a case report complaining of generalized abdominal pain and several episodes of non-bilious bloodless vomiting. The patient was admitted to the surgical service department for further investigation, and his abdominal CT scan revealed PI. CLINICAL DISCUSSION The patient underwent emergency laparotomy surgery due to progressive abdominal pain and peritonitis. The involved segment of the small intestine was resected, and ileo-ileal anastomosis was performed. The patient was discharged from the hospital after a week, stable, and in good medical condition. CONCLUSION This article intends to emphasize that although most of the patients with PI are asymptomatic or show unspecific symptoms, surgeons must take into account rare but lethal complications of PI such as intestinal volvulus. Early recognition of such complications is so crucial and can be life-saving.
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Affiliation(s)
| | - Fatemeh Chinisaz
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Mohammadi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosrow Najjari
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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18
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Zouaghi A, Hadded D, Meryam M, Benzarti Y, Cherif M, Zaafouri H, Ben Massoud K, Chamekhi C, Ben Maamer A. Case Report: An unusual case of small bowel volvulus associated with pneumatosis intestinalis. F1000Res 2021; 10:951. [PMID: 36483602 PMCID: PMC9706145 DOI: 10.12688/f1000research.73042.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/04/2023] Open
Abstract
Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis.
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Affiliation(s)
- Alia Zouaghi
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Dhafer Hadded
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mesbahi Meryam
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Yazid Benzarti
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mona Cherif
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Haithem Zaafouri
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Khalil Ben Massoud
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Chiraz Chamekhi
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
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19
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Zouaghi A, Hadded D, Meryam M, Benzarti Y, Cherif M, Zaafouri H, Ben Massoud K, Chamekhi C, Ben Maamer A. Case Report: An unusual case of small bowel volvulus due to appendicitis associated with pneumatosis intestinalis: Review of the literature. F1000Res 2021; 10:951. [PMID: 36483602 PMCID: PMC9706145 DOI: 10.12688/f1000research.73042.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pneumatosis cystoid intestinalis is a rare disease reported in the literature affecting 0.03% of the population. It has a variety of causes and its manifestation may change widely. It usually presents as a marginal finding resulting from various gastrointestinal pathologies. In the acute complicated form of pneumatosis intestinalis, management is challenging for physicians and surgeons. We present a case of a 60-year-old patient who was admitted to our surgical department with a symptomatology suggestive of small bowel occlusion. Computed tomography demonstrated ileal volvulus associated with parietal signs suffering and pneumoperitoneum. An emergent exploratory laparoscopy followed by conversion was performed demonstrating segmental ileal pneumatosis intestinalis secondary to a small bowel volvulus due to an inflammatory appendix wrapping around the distal ileum. Further, detorsion, retrograde draining, and appendectomy were performed because there were no signs of necrosis and the appendix was pathological. The postoperative course was uneventful. This case is exceedingly rare in the literature, because it was featured by the ileal volvulus due to appendicitis.This case report emphasizes the importance of surgical procedures in the management of symptomatic pneumatosis intestinalis associated to an acute abdomen.
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Affiliation(s)
- Alia Zouaghi
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Dhafer Hadded
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mesbahi Meryam
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Yazid Benzarti
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Mona Cherif
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Haithem Zaafouri
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Khalil Ben Massoud
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Chiraz Chamekhi
- Department of Radiology, Habib Thameur Hospital, Tunis, Tunis, 1000, Tunisia
| | - Anis Ben Maamer
- Department of General Surgery, Habib thameur Hospital, Tunis, Tunis, 1000, Tunisia
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20
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Pneumatosis cystoides intestinalis, a rare case in a pediatric patient following allogeneic hematopoietic stem cell transplantation: CT findings and literature review. Radiol Case Rep 2021; 16:3120-3124. [PMID: 34457100 PMCID: PMC8377547 DOI: 10.1016/j.radcr.2021.07.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 01/04/2023] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of gas-filled cysts in the subserosa or submucosa of the bowel wall. It is associated with various disorders including chronic obstructive pulmonary diseases, autoimmune disorders, and organ transplantation. PCI has also been observed following Hematopoietic Stem Cell Transplantation (HSCT), associated with chemotherapy, acute Graft versus Host Disease (GvHD), immunosuppression, and infections. Computed tomography (CT) provides an easy diagnosis because it highlights the presence of air bubbles in the intestinal wall and possible pneumoperitoneum. We report the case of a patient with severe acquired medullary aplasia undergoing allogeneic HSCT with subsequent development of cutaneous GvHD and an incidental finding of PCI during a CT scan of the chest in absence of gastrointestinal symptoms. Our work aims at clarifying a possible complication in pediatric patients undergoing HSCT to guide young or non-pediatric radiologists in the identification of this rare condition, helping the clinician in the correct conservative management of these patients and reserving the surgical treatment only to specific complications.
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21
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Dibra R, Picciariello A, Trigiante G, Labellarte G, Tota G, Papagni V, Martines G, Altomare DF. Pneumatosis Intestinalis and Hepatic Portal Venous Gas: Watch and Wait or Emergency Surgery? A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923831. [PMID: 32653891 PMCID: PMC7377522 DOI: 10.12659/ajcr.923831] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 60-year-old Final Diagnosis: Pneumatosis intestinalis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Rigers Dibra
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Grazia Labellarte
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Giovanni Tota
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Vincenzo Papagni
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Gennaro Martines
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Donato F Altomare
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
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22
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Molina GA, Fuentes G, Orejuela ME, Herrera JM, Jiménez GE, Pinto JC, Cobo MM. Pneumatosis cystoides intestinalis in an elderly patient, better to be safe than sorry. J Surg Case Rep 2020; 2020:rjaa053. [PMID: 32280437 PMCID: PMC7136705 DOI: 10.1093/jscr/rjaa053] [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: 12/13/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 12/21/2022] Open
Abstract
Pneumatosis cystoides intestinalis is a rare pathology with nonspecific symptoms that can be easily misdiagnosed. Clinical awareness along with close surveillance is critical to effectively diagnose and treat this condition. Current treatment is based on conservative therapy including antibiotics and oxygen. Surgery is only recommended when complications are suspected. Here, we present the case of a 72-year-old female admitted to the emergency department with abdominal pain and vomits. Pneumatosis cystoides intestinalis was diagnosed and was successfully treated. On follow-up visits, patient is recovering and doing well.
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Affiliation(s)
- Gabriel A Molina
- Department of General Surgery at Hospital, IESS Quito Sur, Quito, Ecuador
| | - Germanico Fuentes
- Department of General Surgery at Hospital, IESS Quito Sur, Quito, Ecuador
| | | | | | | | | | - Maria Mercedes Cobo
- College of Biological and Environmental Sciences, Universidad San Francisco de Quito, USFQ, Quito, Ecuador
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