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Tsang CF, Davis B, Chan DL, Yeo D. A rare case of benign pneumatosis intestinalis in Sjogren's syndrome. J Surg Case Rep 2023; 2023:rjad346. [PMID: 37337533 PMCID: PMC10276977 DOI: 10.1093/jscr/rjad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
Pneumatosis intestinalis (PI)-the presence of intramural bowel gas-is an uncommon radiological finding, the severity of which depends on the underlying pathological process, ranging from benign disease to life-threatening ischaemia and intra-abdominal sepsis. PI has been described in systemic sclerosis and mixed connective tissue disease; however, few cases have been reported in Sjogren's syndrome (SjS). The exact pathogenesis of PI in systemic connective tissue disorders is not fully understood and likely multifactorial. We have described a unique case of PI without evidence of peritonitis in a stable patient with long-standing SjS managed non-operatively. An awareness of such benign PI, particularly amongst patients with systemic connective tissue disease, is crucial for diagnostic accuracy and safe patient care, particularly in preventing unnecessary surgical intervention.
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Affiliation(s)
- Chi F Tsang
- Correspondence address. P.O. Box 21502, World Square, Sydney, NSW 2002, Australia. E-mail:
| | - Brandon Davis
- Department of General Surgery, St George Hospital, Sydney, NSW, Australia
| | - Daniel L Chan
- Department of General Surgery, St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - David Yeo
- Department of General Surgery, St George Hospital, Sydney, NSW, Australia
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Kyaw NK, Abubakar M, Shekhda KM, Tageldeen R, Afifi W, Halliru FM, Ibrahim YW. Man with Acute Abdomen. Oman Med J 2023; 38:e473. [PMID: 36825247 PMCID: PMC9941422 DOI: 10.5001/omj.2023.09] [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: 04/27/2021] [Accepted: 09/25/2021] [Indexed: 11/03/2022] Open
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Miyara SJ, Becker LB, Guevara S, Kirsch C, Metz CN, Shoaib M, Grodstein E, Nair VV, Jandovitz N, McCann-Molmenti A, Hayashida K, Takegawa R, Shinozaki K, Yagi T, Aoki T, Nishikimi M, Choudhary RC, Cho YM, Zanos S, Zafeiropoulos S, Hoffman HB, Watt S, Lumermann CM, Aronsohn J, Shore-Lesserson L, Molmenti EP. Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York. Front Med (Lausanne) 2021; 8:638075. [PMID: 34150792 PMCID: PMC8212022 DOI: 10.3389/fmed.2021.638075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia-reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.
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Affiliation(s)
- Santiago J. Miyara
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Lance B. Becker
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Sara Guevara
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Claudia Kirsch
- Department of Radiology, North Shore University Hospital, Manhasset, NY, United States
| | - Christine N. Metz
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Muhammad Shoaib
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Elliot Grodstein
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Vinay V. Nair
- Department of Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Nicholas Jandovitz
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Pharmacy, North Shore University Hospital, Manhasset, NY, United States
| | | | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Koichiro Shinozaki
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Tsukasa Yagi
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Tomoaki Aoki
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Mitsuaki Nishikimi
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Young Min Cho
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Stavros Zanos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Hannah B. Hoffman
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Stacey Watt
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Claudio M. Lumermann
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States
| | - Judith Aronsohn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States
| | - Linda Shore-Lesserson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States
| | - Ernesto P. Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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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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Pneumatosis intestinalis with pneumoperitoneum: Not always a surgical emergency. Radiol Case Rep 2020; 15:2459-2463. [PMID: 33014230 PMCID: PMC7522584 DOI: 10.1016/j.radcr.2020.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/21/2022] Open
Abstract
Pneumatosis intestinalis (PI) and pneumoperitoneum are commonly recognized as severe signs of gastrointestinal diseases that require emergency surgery. However, these symptoms can also be caused by benign conditions. We describe 4 cases of benign PI and pneumoperitoneum that were detected in different clinical situations (accidental discovery in bilan of aortic dissection (case #1), bilateral pulmonary embolism (case #2), overflow diarrhea due to fecal impaction (case #3), and in follow-up postbiliary digestive anastomosis surgery (case #4), which were addressed with exploratory surgery (case #1) or conservative treatment (the remaining cases), with favorable outcomes. Because PI and pneumoperitoneum can be associated with both life-threatening causes and benign conditions, treatment decisions should be based on the correspondence between clinical and paraclinical features, rather than imaging alone.
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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: 14] [Impact Index Per Article: 3.5] [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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Ribolla M, Conti L, Baldini E, Palmieri G, Grassi C, Banchini F, Dacco' MD, Capelli P. Asymptomatic pneumoperitoneum in pneumatosis coli: A misleading operative indication. Int J Surg Case Rep 2020; 69:92-95. [PMID: 32305029 PMCID: PMC7163289 DOI: 10.1016/j.ijscr.2020.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/14/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a rare clinical pathology characterized by sub-mucosal and/or sub-serous cysts of free gas, forming cystic lesions usually ranging from 0.5 to 2.0 cm in size within the gastrointestinal tract. About 3% of patients with PCI develop complications such as pneumoperitoneum, intestinal volvulus, obstruction, or hemorrhage, these cases need immediate surgical intervention. Cyst rupture can produce peritoneal irritation and pneumoperitoneum. PRESENTATION OF CASE A 65-years-old woman was admitted to the Emergency Department for epileptiform convulsions. Her medical hystory included epilepsy, diabetes, lichenoid dermatitis, hypothyroidism, severe cognitive impairment. Abdominal CT scan revealed a dilated large intestine with parietal pneumatosis from the appendix to the transverse colon associated to extensive pneumoperitoneum. The patient underwent emergency laparotomy which revealed the presence of gas within the wall of right and transverse colon and distension of great omentum. No resection was needed as normal blood supply to the bowel present. DISCUSSION Pneumatosis coli can be both asymptomatic or life-threatening condition associated to bowel infarction; this situation can mimic a bowel perforation causing pneumoperitoneum - that sometimes is a non-surgical pneumoperitoneum - and it could be a misleading indication to surgical exploration especially in the case of uncertain origin of a septic shock. CONCLUSIONS We report a case of pneuomoperitoneum due to PCI. Surgical intervention was required for patient's conditions and unclear origin of the sepsis.
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Affiliation(s)
- Marta Ribolla
- Department of Medicine and Surgery, AOU Parma, Via Gramsci 14, Parma, Italy
| | - Luigi Conti
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy.
| | - Edoardo Baldini
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
| | - Gerardo Palmieri
- Department of Medicine and Surgery, AOU Parma, Via Gramsci 14, Parma, Italy
| | - Carmine Grassi
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
| | - Filippo Banchini
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
| | | | - Patrizio Capelli
- Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy
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Dhadlie S, Mehanna D, McCourtney J. Pneumatosis intestinalis a trap for the unwary: Case series and literature review. Int J Surg Case Rep 2018; 53:214-217. [PMID: 30428434 PMCID: PMC6232619 DOI: 10.1016/j.ijscr.2018.10.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/06/2022] Open
Abstract
Pneumatosis Intestinalis is a rare condition that may manifest with a wide range of symptoms from mild abdominal pain to acute peritonitis. In general, surgery is only indicated in symptomatic patients where medical therapy has failed and in patients presenting acutely unwell with a surgical abdomen. Treatment is generally medical and even with radiological evidence of perforation laparotomy may not be indicated if the patient is clinically well. Treatment with oxygen or hyperbaric oxygen has been shown to be effective.
Introduction Pneumatosis Intestinalis (PI) can present with a broad range of presentations from chronic and non-specific to acute and life threatening. It is paradoxically one of the few conditions where a pneumoperitoneum found in the diagnostic workup is not necessarily an indication for laparotomy. Presentation of cases The first case is of a 75 year old gentlemen who attended the emergency department after several weeks of worsening abdominal pain and weight loss. At laparotomy, two segments of nodular, abnormal-looking small bowel were identified with bubbles of air seen in the small bowel mesentery. The second case is of an 86 year old man with of a 5-month history of abdominal pain, weight loss, nausea and diarrhoea. A subsequent endoscopy revealed diffuse gastritis with a small antral gastric ulcer with a small amount of blood. The CT scan demonstrated free air within the bowel wall, with a follow up scan performed 3 weeks later revealing an increase in the amount of free air. Discussion PI is a rare condition characterised by the presence of subserosal and submucosal gas filled cysts occurring anywhere in the gastrointestinal tract from the oesophagus to the anus. Numerous conditions have been associated with PI including bowel obstruction, infections, ischemia and there have been reported cases suggesting as association with Crohn’s disease. Conclusion PI is a condition that may manifest with a wide range of symptoms from mild abdominal pain to acute peritonitis. Its treatment is generally medical and even with radiological evidence of perforation laparotomy may not be indicated if the patient is clinically well.
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Affiliation(s)
- Sunny Dhadlie
- Caboolture Hospital, 120 McKean Street, 4510, Queenland, Australia.
| | - Daniel Mehanna
- Caboolture Hospital, 120 McKean Street, 4510, Queenland, Australia.
| | - James McCourtney
- Royal Alexandra Hospital, Corsebar Rd, Paisely, PA2 9PN, Scotland, UK.
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Furihata T, Furihata M, Ishikawa K, Kosaka M, Satoh N, Kubota K. Does massive intraabdominal free gas require surgical intervention? World J Gastroenterol 2016; 22:7383-7388. [PMID: 27621584 PMCID: PMC4997647 DOI: 10.3748/wjg.v22.i32.7383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/24/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
We describe a rare case of an 81-year-old man who presented with severe epigastralgia. A chest radiograph showed massive free gas bilaterally in the diaphragmatic spaces. Computed tomography (CT) scan also showed massive free gas in the peritoneal cavity with portal venous gas. We used a wait-and-see approach and carefully considered surgery again when the time was appropriate. The patient received conservative therapy with fasting, an intravenous infusion of antibiotics, and nasogastric intubation. The patient soon recovered and was able to start eating meals 4 d after treatment; thus, surgical intervention was avoided. Thereafter, colonoscopy examination showed pneumatosis cystoides intestinalis in the ascending colon. On retrospective review, CT scan demonstrated sporadic air-filled cysts in the ascending colon. The present case taught us a lesson: the presence of massive intraabdominal free gas with portal venous gas does not necessarily require surgical intervention. Pneumatosis cystoides intestinalis should be considered as a potential causative factor of free gas with portal venous gas when making the differential diagnosis.
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Phothong N, Swangsri J, Akaraviputh T, Chinswangwatanakul V, Trakarnsanga A. Colonic stenting for malignant colonic obstruction with pneumatosis intestinalis: A case report. Int J Surg Case Rep 2016; 26:38-41. [PMID: 27448227 PMCID: PMC4957606 DOI: 10.1016/j.ijscr.2016.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/24/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023] Open
Abstract
Pneumatosis intestinalis is characterized by the presence of air localizing in the submucosa and subserosa layers of the bowel wall. Because of its risk of impending perforation, emergency surgery is generally required to be a definite treatment. Colonic stenting can be used as a safe alternative procedure in the selected patient.
Introduction Pneumatosis intestinalis is one of serious conditions following mechanical bowel obstruction. Emergency surgery is generally required to be a definite treatment in these patients of pneumatosis intestinalis, because of its risk of bowel ischemia and perforation. Since the operation in unprepared colon usually resulted in unfavorable outcome, the use of colonic stent is considered one of potential options as a bridge to definitive surgery. Presently, there is no widely published report of using colonic stent in these patients, particularly for stepping to curative surgery. Therefore, we herein report a case of obstructing sigmoid cancer with pneumatosis intestinalis who underwent successfully emergency metallic stent placement to convert from emergency to elective surgery. Presentation of case A 50-year-old woman presented with 3-day history of abdominal pain and obstipation. Abdominal computed tomography demonstrated a short segment of circumferential luminal narrowing at sigmoid colon, the presence of pneumatosis intestinalis at cecum, including ascending colon, and no extraluminal air. We performed colonoscopy and placed the metallic stent. The patient was then improved. After 1 week, the patient underwent elective hand-assisted laparoscopic sigmoidectomy and was discharged 5 days later. Pathological report showed stage IIa sigmoid cancer. The patient had no local recurrence or distant metastasis in 1 year follow up. Conclusion In obstructing colonic patient with pneumatosis intestinalis, nonsurgical treatment by colonic stenting can be used in selected patient as a bridge to definitive surgery. This will result in decreased morbidity and mortality and lower rate of stoma formation.
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Affiliation(s)
- Natthawut Phothong
- Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand; Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Pak Kret, Nonthaburi, 11120, Thailand
| | - Jirawat Swangsri
- Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
| | - Thawatchai Akaraviputh
- Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand.
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Maeda A, Nakata M, Shimizu K, Yukawa T, Saisho S, Okita R. Pneumatosis intestinalis after gefitinib therapy for pulmonary adenocarcinoma: a case report. World J Surg Oncol 2016; 14:175. [PMID: 27495256 PMCID: PMC4974742 DOI: 10.1186/s12957-016-0926-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 06/15/2016] [Indexed: 12/21/2022] Open
Abstract
Background Pneumatosis intestinalis (PI) is defined as the presence of gas in the bowel wall and is a relatively rare finding. PI has been associated with various pathological conditions and medications. Although several chemotherapeutic agents and molecular targeted therapy agents are reported to be associated with PI, there have been few reports describing the association between the anti-epidermal growth factor receptor agent gefitinib, a tyrosine kinase inhibitor (TKI), and PI. The present report describes a case of PI secondary to gefitinib therapy. Case presentation An 80-year-old woman who had been diagnosed with recurrent lung adenocarcinoma presented with remarkable appetite loss, abdominal distension, and constipation after starting gefitinib therapy. A computed tomography (CT) scan of the abdomen revealed PI extending from the small intestine to the rectum. The patient was managed conservatively, and gefitinib therapy was discontinued. Subsequently, the symptoms improved and a follow-up abdominal X-ray showed a reduction in intramural air. After gefitinib was restarted, PI occurred three more times. Conclusions Although PI is extremely rare, physicians should be aware of the risk of PI in patients undergoing gefitinib therapy.
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Affiliation(s)
- Ai Maeda
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Katsuhiko Shimizu
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Takuro Yukawa
- Department of General Surgery, Kawasaki Medical School, Okayama, Okayama, 700-8505, Japan
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Riki Okita
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Pneumatosis cystoidis intestinalis presenting as bowel perforation, a rare entity. Int J Surg Case Rep 2016; 20:7-9. [PMID: 26774416 PMCID: PMC4818287 DOI: 10.1016/j.ijscr.2015.12.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 12/23/2015] [Accepted: 12/25/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is an uncommon condition. This following article describes a case of primary PCI presenting as acute abdomen due to perforation of a small bowel cyst. PRESENTATION OF CASE This following article describes the case of an 88 year-old woman admitted at the hospital with peritonitis and consequently operated for a presumed bowel ischemia and perforation. However surgical exploration revealed perforated PCI. DISCUSSION The pathophysiology of secondary PCI is poorly understood. Gas produced by Gas-forming bacteria may enter the mucosal barrier due and consequently this gas accumulates within the bowel wall. Also malnutrition can prevent the digestion of carbohydrates, which leads to increased bacterial fermentation, and production of large volumes of gas leading to distention and ischemia and subsequently the submucosal dissection of gas. Colonoscopy is helpful in excluding other colonic lesions and it shows the submucosal cysts that have a typical dual appearance: multiple white small cysts coupled to a sub-atrophic mucosa or larger cysts (up to 3cm) with a reddened overlying mucosa. CONCLUSION The treatment unless complicated should be conservative even in the presence of pneumoperitoneum, after excluding complications.
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13
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Zorgdrager M, Pol R. Pneumatosis intestinalis associated with enteral tube feeding. BMJ Case Rep 2013; 2013:bcr-2013-009378. [PMID: 24302661 DOI: 10.1136/bcr-2013-009378] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man presented with a Hinchey II perforated diverticulitis and underwent laparoscopic peritoneal lavage. During the postoperative course the patient received enteral tube feeding which was followed by a bowel obstruction accompanied with pneumatosis intestinalis (PI). Explorative laparotomy showed an omental band adhesion without signs of ischaemia. After a short period of total parenteral nutrition PI resolved almost completely and enteral tube feeding could be continued once again. In the weeks that followed the patient developed atypical bowel symptoms and recurrent PI which resolved each time the drip feeding was discontinued. Despite the mild clinical course, a CT scan showed massive PI on day 21 after the laparotomy. After excluding life-threatening conditions conservative management was instituted and the patient recovered completely after discontinuing the drip feeding. We present one of the few cases of subclinical PI associated with enteral tube feeding that could be managed conservatively.
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Wu LL, Yang YS, Dou Y, Liu QS. A systematic analysis of pneumatosis cystoids intestinalis. World J Gastroenterol 2013; 19:4973-4978. [PMID: 23946603 PMCID: PMC3740428 DOI: 10.3748/wjg.v19.i30.4973] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/02/2013] [Accepted: 07/01/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To increase the understanding, diagnosis and treatment of pneumatosis cystoides intestinalis (PCI) and to find the characteristics and potential cause of the disease in China.
METHODS: We report here one case of PCI in a 70-year-old male patient who received a variety of treatment methods. Then, we systematically searched the PCI eligible literature published from an available Chinese database from May 2002 to May 2012, including CBM, CBMDisc, CMCC, VIP, Wanfang, and CNKI. The key words were pneumatosis cystoides intestinalis, pneumatosis, pneumatosis intestinalis, pneumatosis coli and mucosal gas. The patients’ information, histories, therapies, courses, and outcomes were reviewed.
RESULTS: The study group consisted of 239 PCI cases (male:female = 2.4:1) from 77 reported incidents. The mean age was 45.3 ± 15.6 years, and the median illness course was 6 mo. One hundred and sixty patients (66.9%) were in high altitude areas. In addition, 43.5% (104/239) of the patients had potential PCI-related disease, and 16.3% had complications with intestinal obstruction and perforation. The most common symptom was abdominal pain (53.9%), followed by diarrhea (53.0%), distention (42.4%), nausea and vomiting (14.3%), bloody stool (12.9%), mucous stool (12.0%) and constipation (7.8%). Most multiple pneumocysts developed in the submucosa of the colon (69.9%). The efficacy of the treatments by combined modalities, surgery, endoscopic treatment, conservative approach, oxygen, and antibiotics were 100%, 100%, 100%, 93.3%, 68.3% and 26.3%, respectively.
CONCLUSION: PCI can be safely managed by conservative treatments, presents more frequently in males, in the large bowel and submucosa, than in females, in the small intestine and subserosa. High altitude residence maybe associated with the PCI etiology.
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