PNEUMATOSIS CYSTOIDES INTESTINALIS ASSOCIATED WITH ABDOMINAL CARCINOMATOSIS

Pneumatosis Intestinalis of the Colon and Greater Omentum following Small Bowel Resection

Introduction. Pneumatosis intestinalis (PI) is a condition of gas collection within the bowel wall that can represent either a benign clinical finding or a forerunner to potential gastrointestinal catastrophe. As a potentially sinister discovery typically first detected on radiographic imaging, clinicians need to astutely assess the need for additional urgent medical or surgical management in these patients. Apart from portal venous gas, PI outside of the bowel wall is an extremely rare entity that is poorly described. Hence, it is not necessarily clear if PI outside the bowel wall warrants more aggressive management. Case Presentation. We describe a patient with intermittent abdominal pain who presented with PI of the greater omentum in addition to the right and transverse colon nearly two weeks after small bowel resection. Due to his clinical stability, we elected to closely observe him. His condition completely resolved with conservative management. Discussion. PI in the omentum has not been described in a patient who has survived their underlying pathology. Our patient demonstrated PI radiographically in his right and transverse colon and omentum with complete resolution. We did not have to alter our clinical management because of this unique clinical presentation. Conclusion. This case highlights that pneumatosis intestinalis can extend extraluminally and still be managed conservatively with judicious monitoring in the otherwise stable patient.

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

Pneumatosis intestinalis is a radiographic finding that represents a spectrum of conditions ranging from benign disease to abdominal sepsis and death. Along with portal venous gas, it is generally considered an ominous sign prompting emergency operative intervention. We report a rare case showing that nonoperative therapy can be considered in a seriously ill patient with esophageal, gastric and portal venous air.

Incidental finding of esophageal pneumatosis

Pneumatosis of the gastrointestinal tract is a rare condition characterized by the presence of air filled cavities in the gastrointestinal tract wall. Its occurrence has been described throughout the gastrointestinal tract from the esophagus to the rectum, however it is most commonly reported in the small intestine. Despite multiple case reports in literature, its pathogenesis still remains unclear. Pneumatosis may be idiopathic or associated with a variety of disorders namely peptic ulcer disease, jejunoileal bypass, intestinal obstruction and non-gastrointestinal disorders like asthma, chronic obstructive pulmonary disease, systemic lupus erythematosus, infectious enteritis, etc. We here present a rare case of pneumatosis of the esophagus diagnosed incidentally at an esophagogastroduodenoscopy (EGD). A 78-year-old asymptomatic woman underwent EGD and colonoscopy at our hospital for evaluation of anemia. Few months prior to EGD, she had undergone excision of laryngocele at our hospital. EGD revealed extensive submucosal blebs distributed throughout the esophagus, otherwise unremarkable stomach and duodenum. Colonoscopy showed a tubular adenomatous polyp. Since our patient was asymptomatic she did not require any surgical intervention. Management of pneumatosis depends on the underlying cause.

Pneumatosis cystoides intestinalis associated with pyloric stenosis

Pneumatosis cystoides intestinalis is a rare condition characterized by the presence of gas-filled cysts in the bowel wall. A case is reported which was associated with peptic ulcer and in which there was involvement of the ileum and pre-pyloric region of the stomach. Stomach involvement is a rare occurrence. Chronic pneumoperitoneum was also present. The mechanism of its occurrence is discussed.

Treatment of pneumatosis cystoides coli by oxygen inhalation

Endotracheal intubation and intermittent positive pressure ventilation were used to overcome the difficulties of oxygen therapy for pneumatosis cystoides coli in a 9-year-old child with Down's syndrome and a congenital heart defect. As compared to previously reported cases, a shorter duration of treatment and a lower arterial oxygen tension proved successful.

Pneumatosis cystoides intestinalis

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