Pneumatosis intestinalis with obstructing intussusception: A case report and literature review

Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy: A case report and review of literature

BACKGROUND

Pneumatosis cystoides intestinalis (PCI), characterized by a collection of gas-filled cysts in the intestinal wall, is an uncommon but well-known condition in gastroenterology. Abdominal pain is the most frequent symptom associated with PCI. Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation. However, the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.

CASE SUMMARY

A 52-year-old male, known with idiopathic PCI, presented seventeen months after initial diagnosis with a new right upper quadrant pain. A computed tomography-scan demonstrated a colonic intussusception at the hepatic flexure. PCI did not progress compared with initial investigation. The patient underwent an emergency right hemicolectomy.

CONCLUSION

Resection was recommended in this case because PCI proved to be persisting with no identified curable cause. Surgery allowed to address the underlying pathology, the potential relapse of intussusception, and the likely cause of recurrent abdominal pain, either invagination or PCI itself.

Intestinal pneumatosis: differential diagnosis

Intestinal pneumatosis (IP) is an infrequent radiological sign defined as pathological gas infiltration into the bowel wall. It may be associated to different underlying clinical conditions-inflammatory bowel diseases, malignancies, chemotherapy, infections, immune deficiency status, trauma, intestinal ischemia, and necrosis-that are often related to emergency state and require a prompt diagnosis. All the imaging techniques, especially abdominal radiography and Computed Tomography, could detect the presence of IP and discern the forms related to emergency conditions. The differential diagnosis is essential to start an immediate clinical or surgical management and treatment. The aim of this article is to review the radiological features of IP in different illnesses, with particular attention to differential diagnosis.

The Correlation Between Pediatric Intussusceptions and Celiac Disease

The most common acute abdominal disorder in the pediatric population appears as a telescoping of the bowel, resulting in either intermittent or complete obstruction. Intussusceptions transpire as the bowel prolapses into a more distal bowel segment and is propelled forward. A case is presented of multiple small bowel intussusceptions, pneumatosis, intraperitoneal fluid, and pericardial effusion. Sonography initially visualized the obstructions, along with multiple other indicators of an abdominal disorder. The use of computed tomography followed to provide a more comprehensive view of the child’s abdomen. Each imaging technique revealed new aspects of the abdominal disorder and concluded in the diagnosis of celiac disease. This case supports the idea that small bowel intussusceptions should not be disregarded as insignificant incidental findings but rather should alert sonographers to further investigate for evidence of celiac disease.

Gastrointestinal malignant neoplasms disguised as pneumatosis cystoids intestinalis: A case report and literature review

RATIONALE

Pneumatosis cystoids intestinalis (PCI) is a rare disease in which gas develops in the mucosa or submucosa of the digestive tract. The etiology and pathogenesis of this disease, at present, remain unclear, and gastrointestinal malignant neoplasms may be a potentially important cause. Herein, we report a case of mantle cell lymphoma presenting as PCI as well as present a literature review of cases of suspect PCI that was definitively diagnosed as gastrointestinal neoplasms. In doing so, we highlighted cases of neoplastic pathogenesis that present as PCI.

PATIENT CONCERNS

A 55-year-old man was referred to our gastrointestinal department with complaints of intermittent abdominal pain, distention, diarrhea, and occasional melena that persisted for 2 months. He has a history of nasopharyngeal carcinoma.

DIAGNOSES

Intensive, translucent, grape-like cystoids of the whole colon and small intestine were disguised as PCI upon colonoscopy and capsule endoscopy.

INTERVENTIONS

Right hemicolectomy and ileocecectomy were performed for intussusception and to confirm the diagnosis. Final pathology indicated that the mass was mantle cell lymphoma.

OUTCOMES

After surgery and subsequent chemotherapy, the patient showed good recovery and no abnormal lesions were detected on colonoscopy.

LESSONS

As shown through this case and a literature review of similar cases of apparent PCI that was definitively diagnosed as gastrointestinal neoplasm, gastrointestinal malignant neoplasms might rarely present as PCI and neoplastic etiologies should also be considered once PCI is detected. Because most patients with malignant PCIs might inevitably experience severe complications, abdominal surgery should be considered and applied timely after unsuccessful resolution by conservative medical therapies and symptomatic treatments.