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Dirhoussi LB, Latinis F. Incidental pneumatosis intestinalis in a patient with chronic kidney disease: a case report. J Surg Case Rep 2025; 2025:rjaf168. [PMID: 40161885 PMCID: PMC11954369 DOI: 10.1093/jscr/rjaf168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 03/08/2025] [Indexed: 04/02/2025] Open
Abstract
Pneumatosis intestinalis (PI) is a clinical condition characterized by the presence of gas within the bowel wall and is considered a rare medical finding. While PI may be harmless in some cases, it can also signal more severe gastrointestinal pathology, including ischemia, bowel obstruction, or perforation. We present the case of an 87 year old male with end-stage kidney disease undergoing hemodialysis (HD), in whom PI was incidentally discovered during a follow up computed tomography (CT) performed for a renal mass. The patient was asymptomatic, and the CT findings showed no signs of ischemia, bowel obstruction or perforation. This case underscores the importance of correlating clinical and imaging data to avoid unnecessary surgery interventions. Additionally, it provides a comprehensive review of the pathogenesis, causes, diagnosis and management of PI. Further research is warranted to investigate the potential link between chronic kidney disease, HD, and the development of PI.
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Affiliation(s)
- Lina Berrada Dirhoussi
- Department of Visceral Surgery, Établissement Hospitalier de Nord Vaudois (eHNV), Yverdon-les-Bains, 1400 Vaud, Switzerland
| | - Florence Latinis
- Department of Visceral Surgery, Établissement Hospitalier de Nord Vaudois (eHNV), Yverdon-les-Bains, 1400 Vaud, Switzerland
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2
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Habeb B, Khair S, Fowler M. A Rare Case of Postoperative Pneumatosis Intestinalis Complicated by Sigmoid Colon Perforation Requiring Immediate Surgical Intervention. Cureus 2025; 17:e78480. [PMID: 40051934 PMCID: PMC11884214 DOI: 10.7759/cureus.78480] [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: 02/04/2025] [Indexed: 03/09/2025] Open
Abstract
Pneumatosis intestinalis (PI) is a rare but potentially serious gastrointestinal condition with diverse clinical presentations. Pneumatosis intestinalis is identified by the presence of gas in the extraluminal intestinal wall and is further subclassified into benign pneumatosis intestinalis (BPI) and life-threatening pneumatosis intestinalis (LTPI). Prompt and accurate diagnosis, often aided by imaging studies, is crucial to guide appropriate management. Treatment strategies vary depending on the severity of symptoms and underlying etiologies. Collaboration between gastroenterology, radiology, and general surgery is essential to optimize patient outcomes in cases of PI. Herein, we present a case of PI complicated with intestinal perforation that was managed surgically.
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Affiliation(s)
- Bola Habeb
- Internal Medicine, University of Florida College of Medicine, Ascension Sacred Heart, Pensacola, USA
| | - Sandy Khair
- Radiation Oncology, Cairo University, National Cancer Institute, Cairo, EGY
| | - Matthew Fowler
- Internal Medicine, University of Florida College of Medicine, Ascension Sacred Heart, Pensacola, USA
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3
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Ong WM, Ng SC. Pneumatosis cystoides intestinalis - an endoscopic rarity. ANZ J Surg 2024; 94:2073-2074. [PMID: 39440893 DOI: 10.1111/ans.19217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 10/25/2024]
Affiliation(s)
- Wei Ming Ong
- Monash University, Melbourne, Victoria, Australia
| | - Suat Chin Ng
- Melbourne University, Melbourne, Victoria, Australia
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Bezabih NA, Mehammed AH, Gebresilassie MY, Damtie MY, Midekso HD, Gidna EK. A rare case of extensive pneumatosis cystoides intestinalis with intestinal malrotation: Case report. Radiol Case Rep 2024; 19:5100-5104. [PMID: 39253045 PMCID: PMC11381972 DOI: 10.1016/j.radcr.2024.07.145] [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: 05/24/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/11/2024] Open
Abstract
Intramural bowel gas (Pneumatosis intestinalis) refers to the radiological or clinical evidence of gas within the wall of the bowel lumen. While intramural gas could be secondary to life-threatening pathologies such as mesenteric ischemia in adults and necrotizing enterocolitis in neonates, it could also occur as a rare benign sub-type called Pneumatosis cystoides intestinalis, which is characterized by multiple gas-filled cysts in the submucosa and/or subserosal of the gastrointestinal tract. Distinguishing between life-threatening Pneumatosis intestinalis and its benign subtypes requires careful clinical and imaging evaluation. This involves identifying additional findings that could indicate potentially concerning causes of Pneumatosis intestinalis. Recognizing these signs is essential for effectively managing the patient because conservative management is preferred for Pneumatosis cystoides intestinalis. In this case study, we describe a patient presenting to our hospital with chronic intermittent abdominal pain persisting for about 2 years, accompanied by episodic vomiting. An abdominal CT scan revealed the presence of multiple air-filled cysts within the wall of the mal-rotated cecal bowel loop, which is abnormally located in the right upper quadrant. Associated with this pneumoperitoneum is seen in the peritoneal cavity. No other significant findings were observed on the scan. To our knowledge, this is the first case of pneumatosis cystoid interstinalis occurring in a mal-rotated gut. We also delve into the potential etiologies and management strategies for Pneumatosis cystoides intestinalis, as well as differentiating signs from the life-threatening intramural gas variant.
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Affiliation(s)
- Natnael Alemu Bezabih
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Abdudin Heru Mehammed
- Saint Paul's Hospital Millennium Medical College, Department of Radiology, Addis Ababa, Ethiopia
| | | | - Misganaw Yigletie Damtie
- Saint Paul's Hospital Millennium Medical College, Department of Radiology, Addis Ababa, Ethiopia
| | - Hawi Dida Midekso
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Eden Kasay Gidna
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
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Chen X, Zhao Y, Luo Y, Cai S. An unusual case of multiple colonic polyps. United European Gastroenterol J 2024; 12:1146-1148. [PMID: 39233483 PMCID: PMC11485318 DOI: 10.1002/ueg2.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/15/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
- Xi Chen
- Department of GastroenterologyZhangzhou Traditional Chinese Medicine HospitalZhangzhouChina
- Department of GastroenterologyMulei County People's HospitalMuleiChina
- Fujian University of Traditional Chinese MedicineFuzhouChina
| | - Yongsheng Zhao
- Department of GastroenterologyMulei County People's HospitalMuleiChina
- Fujian University of Traditional Chinese MedicineFuzhouChina
- Chinese Medicine Hospital Changji Hui Autonomous PrefectureChangjiChina
| | - Yiwen Luo
- Department of GastroenterologyMulei County People's HospitalMuleiChina
| | - Shuntian Cai
- Department of GastroenterologyZhongshan Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityXiamenChina
- Xiamen Key Laboratory of Intestinal Microbiome and Human HealthZhongshan Hospital Affiliated to Xiamen UniversityXiamenChina
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Bayissa BB, Fanos B, Tufa DW, Admasu B, Alemu A, Getiye A. Extensive inflammatory adhesion of small bowel with massive Pneumatosis Intestinalis in a patient with gastric outlet obstruction: A rare case report. Int J Surg Case Rep 2024; 122:110152. [PMID: 39154563 PMCID: PMC11378174 DOI: 10.1016/j.ijscr.2024.110152] [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: 07/04/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024] Open
Abstract
INTRODUCTION Pneumatosis Intestinalis (PI) is a rare disease, majority of which are self-limited processes, in which the intestinal sub mucosa and sub serosa are filled with gas-filled cysts. The exact cause and pathogenesis is not well known yet but there are different theories. The two well accepted fundamental pathogenesis is: mechanical and bacterial. CASE PRESENTATION Here we report a case of a 25 years old patient presented with history of persistent vomiting, intermittent abdominal cramp and significant weight loss over three months. The primary diagnosis was made as gastric outlet obstruction with concomitant small bowel extensive PI. DISCUSSION Primary PI has no known cause while secondary type has proposed underlying pathologies with different theorized pathogenesis. The current case report has an underlying pathology of long standing peptic ulcer disease with recent diagnosis of gastric outlet obstruction in favor of the mechanical theory. PI has a broad spectrum of clinical symptoms; ranges from asymptomatic patients to non-specific gastrointestinal symptoms like diarrhea, abdominal distention, weight loss, bloody or mucous stool. Patients with underlying pyloric stenosis, peptic ulcer disease presents with more of upper GI symptoms. Conservative management is usually the treatment of choice. However, surgery must be considered if peritoneal irritation or bowel obstruction appears overt. CONCLUSION Concomitant occurrence of gastric outlet obstruction with small bowel PI is not uncommon disease but severe and extensive inflammatory adhesion was rarely reported. Therefore surgical intervention is mandated for the former or both depending the severity of the PI.
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Affiliation(s)
| | - Besrat Fanos
- Haramaya University, CHMS, Department of Surgery, Ethiopia
| | - Dereje W Tufa
- Haramaya University, CHMS, Department of Radiology, Ethiopia
| | - Berihun Admasu
- Haramaya University, CHMS, Department of Radiology, Ethiopia
| | - Addisu Alemu
- Haramaya University, CHMS, Department of Pathology, Ethiopia
| | - Awoke Getiye
- Haramaya University, CHMS, Department of Anesthesia, Critical care and pain medicine, Ethiopia
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Shi D, Duan X, Li Y, Da M. Colonic pneumatocystosis inducing strangulated bowel obstruction: A case report. Asian J Surg 2024:S1015-9584(24)01438-6. [PMID: 39034236 DOI: 10.1016/j.asjsur.2024.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/20/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Donghai Shi
- The First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xiaoyang Duan
- The First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Yaoqi Li
- Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, 730000, China.
| | - Mingxu Da
- The First School of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China; Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Aguirre Bermudez GA, Torres C, Arredondo Mora N, Falla Quiñones AR. Neumoperitoneo espontáneo: patología no siempre quirúrgica. Presentación de dos casos documentados en pacientes en asociación con infección por SARS-CoV-2. REVISTA COLOMBIANA DE GASTROENTEROLOGÍA 2024; 39:211-218. [DOI: 10.22516/25007440.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
El hallazgo de neumoperitoneo ha sido tradicionalmente una urgencia quirúrgica indicativa de disrupción del tracto gastrointestinal que requiere exploración quirúrgica inmediata; sin embargo, existen condiciones que implican manejo no quirúrgico. Se presentan dos casos de neumoperitoneo en asociación con neumonía viral (coronavirus del síndrome respiratorio agudo grave de tipo 2 [SARS-CoV-2]) sin antecedentes de neumatosis intestinal ni otro factor de riesgo de neumoperitoneo espontáneo que obtuvieron un resultado favorable sin intervención quirúrgica. Este es el segundo informe de neumoperitoneo simultáneo y enfermedad por coronavirus de 2019 (COVID-19) en la literatura. También se incluye una breve revisión sobre esta relación y datos más recientes entre el neumoperitoneo y el mecanismo fisiopatológico del SARS-CoV-2. Este trabajo busca ampliar el conocimiento con estos dos casos para replantear, en parte, el dogma quirúrgico del manejo del neumoperitoneo y llevar al lector un poco más allá desde el punto de vista de la fisiopatología.
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Bergeron E, Pichette M, Boisvert G, Manière T, Désilets É. Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy: A case report and review of literature. World J Clin Cases 2024; 12:3161-3167. [PMID: 38898841 PMCID: PMC11185380 DOI: 10.12998/wjcc.v12.i17.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
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.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Maude Pichette
- Department of Surgery, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Geneviève Boisvert
- Department of Medical Imaging, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Thibaut Manière
- Department of Gastroenterology, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Charles LeMoyne Hospital, Greenfield Park J4V 2H1, Quebec, Canada
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Hattab J, Rosamilia A, Guarnieri C, Sciota D, Marruchella G, Tiscar PG. Intestinal Emphysema and Gut Bacterial Microbiota Composition. Microorganisms 2024; 12:981. [PMID: 38792810 PMCID: PMC11123939 DOI: 10.3390/microorganisms12050981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Pneumatosis cystoides intestinalis, or intestinal emphysema, is a condition characterized by the presence of multiple cystic structures within the gut wall and on the serosal surface of the intestine. Intestinal emphysema represents an accidental finding in swine, although it can be clinically relevant in humans. Its etiology is unknown, and many theories have been proposed. Among them, a bacterial etiology is considered the most likely. Therefore, in this study, the V3-V4 region of the 16S rRNA gene was sequenced from 19 swine ileal tracts, 12 with intestinal emphysema and 7 without lesions, to detect a possible bacterial agent. In parallel, prevalence was estimated. Escherichia-Shigella (13.15%), Clostridium_sensu_stricto_1; s__uncultured_bacterium (7.09%), and Fusobacterium; s_uncultured bacterium (6.60%) were the most abundant species identified. No statistically relevant differences were observed between the pathological and physiological groups. Prevalence ranged from 1.25 to 5.12% depending on the batch. Our results suggest that the gut wall bacterial microbiota greatly match the normal gut microbiota, and that the etiological agent of intestinal emphysema may be (1) undetectable due to the chronicity of the lesions, (2) not considered statistically relevant in comparing the two groups (p < 0.05) and likewise in causing lesions, and (3) undetectable due to contamination. Regarding prevalence, the condition is moderately frequent.
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Affiliation(s)
- Jasmine Hattab
- Department of Veterinary Medicine, University of Teramo, SP18 Piano d’Accio, 64100 Teramo, Italy; (J.H.); (D.S.); (G.M.)
| | - Alfonso Rosamilia
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna “Bruno Ubertini” (IZSLER), 25124 Brescia, Italy;
| | | | - Domenico Sciota
- Department of Veterinary Medicine, University of Teramo, SP18 Piano d’Accio, 64100 Teramo, Italy; (J.H.); (D.S.); (G.M.)
| | - Giuseppe Marruchella
- Department of Veterinary Medicine, University of Teramo, SP18 Piano d’Accio, 64100 Teramo, Italy; (J.H.); (D.S.); (G.M.)
| | - Pietro Giorgio Tiscar
- Department of Veterinary Medicine, University of Teramo, SP18 Piano d’Accio, 64100 Teramo, Italy; (J.H.); (D.S.); (G.M.)
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Aihara Y, Takeshita E, Chiba E, Yamamoto K, Shimizu-Motohashi Y, Sato N, Ariga H, Komaki H. Pneumatosis Cystoides Intestinalis in Muscular Dystrophy and Congenital Myopathies: A Report of Five Cases. Cureus 2024; 16:e61188. [PMID: 38933611 PMCID: PMC11208106 DOI: 10.7759/cureus.61188] [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: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare disease wherein air accumulates in the intestinal subserosa and submucosa, causing multiple gaseous cysts within the gastrointestinal wall. While PCI has various known risk factors, reports identifying muscular diseases as a factor are scarce. The aim of this study is to elucidate the clinical characteristics of PCI in muscle disease. We present a case series of five cases, including two cases of Duchenne muscular dystrophy (DMD) and three cases of rare congenital myopathies. All cases are of male patients, with poor intestinal peristalsis and constipation, who underwent tube feeding and mechanical ventilation via tracheostomy. They had no signs of severe complications, such as intestinal necrosis, and all of them improved with conservative treatment. Case 1 is a 23-year-old man with DMD who developed cardiopulmonary arrest at the age of 20 years. Pulmonary hemorrhage occurred three months before the incidental detection of PCI in the ascending colon, which resolved with conservative oxygen treatment. Case 2 is a 25-year-old man with DMD who progressed to immobility necessitating tracheostomy at the age of 20 years. He experienced persistent abdominal pain and nausea, and PCI was detected in the cecum and ascending colon. He showed near-complete resolution of PCI after three months of conservative treatment. Case 3 is a six-year-old boy with reducing body myopathy. Constipation was diagnosed at four years of age. He experienced intermittent bloody stools, leading to the incidental detection of PCI at six years of age. After two months of conservative treatment, the PCI resolved with no subsequent recurrence. Case 4 is a 33-year-old man with infantile severe myotubular myopathy. He required mechanical ventilation immediately after birth and later underwent tracheostomy and tube feeding due to complications. At the age of 27 years, PCI was incidentally detected on abdominal CT. He had episodes of remission and worsening for a few years; however, PCI completely resolved after three years. Case 5 is a 27-year-old man with nemaline myopathy. At the age of 14 years, he had persistent bloody stools. After lower gastrointestinal endoscopy, he was diagnosed with PCI with numerous rectal cysts. PCI required no specific therapeutic intervention. There was spontaneous resolution of PCI and bloody stools. Given that PCI lacks specific symptoms and cases with muscular diseases often experience abdominal issues, many cases are liable to be overlooked or misdiagnosed. Cases with muscular diseases complaining of persistent abdominal symptoms should undergo radiographic imaging to rule out PCI.
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Affiliation(s)
- Yu Aihara
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Eri Takeshita
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Kaoru Yamamoto
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Yuko Shimizu-Motohashi
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Hajime Ariga
- Department of General Internal Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JPN
- Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, JPN
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Weber NT, Ogle S, Cooper EH, Kaizer AM, Kulungowski AM, Acker SN. Low-risk pneumatosis intestinalis in the pediatric surgical population. Pediatr Surg Int 2024; 40:76. [PMID: 38466447 DOI: 10.1007/s00383-024-05642-y] [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: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Pneumatosis intestinalis (PI, presence of air in bowel wall) develops in a variety of settings and due to a variety of insults which is then characterized by varying severity and clinical course. Anecdotally, many of these cases are benign with few clinical sequelae; however, we lack evidence-based guidelines to help guide management of such lower-risk cases. We aimed to describe the clinical entity of low-risk PI, characterize the population of children who develop this form of PI, determine if management approach or clinical outcomes differed depending on the managing physician's field of practice, and finally determine if a shortened course of NPO and antibiotics was safe in the population of children with low-risk PI. METHODS We performed a retrospective review of all children over age 1 year treated at Children's Hospital Colorado (CHCO), between 2009 and 2019 with a diagnosis of PI who did not also have a diagnosis of cancer or history of bone marrow transplant (BMT). Data including demographic variables, clinical course, and outcomes were obtained from the electronic medical record. Low-risk criteria included no need for ICU admission, vasopressor use, or urgent surgical intervention. RESULTS Ninety-one children were treated for their first episode of PI during the study period, 72 of whom met our low-risk criteria. Among the low-risk group, rates of complications including hemodynamic decompensation during treatment, PI recurrence, Clostridium difficile colitis, and death did not differ between those who received 3 days or less of antibiotics and those who received more than 3 days of antibiotics. Outcomes also did not differ between children cared for by surgeons or pediatricians. CONCLUSIONS Here, we define low-risk PI as that which occurs in children over age 1 who do not have a prior diagnosis of cancer or prior BMT and who do not require ICU admission, vasopressor administration, or urgent surgical intervention. It is likely safe to treat these children with only 3 days of antibiotic therapy and NPO. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nell T Weber
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
| | - Emily H Cooper
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander M Kaizer
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA.
- Center for Children's Surgery, Research Outcomes in Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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Rey Chaves CE, Fonseca JF, Ballen N, Bravo A, Becerra Sarmiento L, Parra Blanco FG, Peña Carvajalino LF, Azula Uribe MC. An unusual case of small bowel volvulus due to pneumatosis cystoides intestinalis: Case report and literature review. Int J Surg Case Rep 2024; 116:109328. [PMID: 38320416 PMCID: PMC10850951 DOI: 10.1016/j.ijscr.2024.109328] [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: 12/29/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Pneumatosis cystoides intestinalis (PCI) is an uncommon condition characterized by intramural gas accumulation in the intestinal submucosa. Idiopathic or secondary is presented with non-specific clinical signs; in some cases, diagnosis is incidental. Its acute presentation is uncommon, and surgical management could be performed in selected cases. CASE PRESENTATION We present the case of an 85-year-old woman with 3 days of abdominal pain, 6 months of weight loss, and abdominal distension after meals. Abdominal computed tomography evidenced PCI at the small intestine with changes due to intestinal ischemia and internal mesenteric hernia. Intestinal resection and lateral-lateral mechanical anastomosis were performed with no complications after 90 days of follow-up. CLINICAL DISCUSSION PCI is an infrequent and benign condition; pathophysiology is, to date, poorly understood. Idiopathic or secondary to other gastrointestinal pathologies are described. The final diagnosis is performed with histopathological analysis. Nevertheless, in some cases, the benign nature could be presented as an acute abdomen, and surgical management should be in the physician's armamentarium. CONCLUSION PCI is an uncommon and benign entity. Nevertheless, in some cases, it could be presented as an acute abdomen. The surgical approach is appropriate, safe, and feasible.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá, Colombia.
| | - Juan Fernando Fonseca
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá, Colombia
| | - Natalia Ballen
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá, Colombia
| | - Andrés Bravo
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá, Colombia
| | | | | | - Laura Felisa Peña Carvajalino
- Patologa, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maria Camila Azula Uribe
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
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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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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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Perrone G, Giuffrida M, Donato V, Petracca GL, Rossi G, Franzini G, Cecconi S, Annicchiarico A, Bonati E, Catena F. The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review. J Pers Med 2024; 14:167. [PMID: 38392601 PMCID: PMC10890206 DOI: 10.3390/jpm14020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE Pneumatosis intestinalis is a radiological finding with incompletely understood pathogenesis. To date, there are no protocols to guide surgical intervention. METHODS A systematic review of literature, according to PRISMA criteria, was performed. Medline and PubMed were consulted to identify articles reporting on the items "emergency surgery, pneumatosis coli, and pneumatosis intestinalis" from January 2010 up to March 2022. This study has not been registered in relevant databases. RESULTS A total of 1673 patients were included. The average age was 67.1 ± 17.6 years. The etiology was unknown in 802 (47.9%) patients. Hemodynamic instability (246/1673-14.7% of the patients) was associated with bowel ischemia, necrosis, or perforation (p = 0.019). Conservative management was performed in 824 (49.2%) patients. Surgery was performed 619 (36.9%) times, especially in unstable patients with bowel ischemia signs, lactate levels greater than 2 mmol/L, and PVG (p = 0.0026). In 155 cases, surgery was performed without pathological findings. CONCLUSIONS Many variables should be considered in the approach to patients with pneumatosis intestinalis. The challenge facing the surgeons is in truly identifying those who really would benefit and need surgical intervention. The watch and wait policy as a first step seems reasonable, reserving surgery only for patients who are unstable or with high suspicion of bowel ischemia, necrosis, or perforation.
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Affiliation(s)
- Gennaro Perrone
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Mario Giuffrida
- Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Valentina Donato
- Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
| | | | - Giorgio Rossi
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Giacomo Franzini
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Sara Cecconi
- Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
| | | | - Elena Bonati
- Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgey, Bufalini Trauma Center, 47023 Cesena, Italy
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Takahashi Y, Shibagaki K, Fukuyama C, Kawashima K, Ishimura N, Kinoshita Y, Ishihara S. Endoscopic fenestration treatment for pneumatosis cystoides intestinalis in patient with recurrent colonic intussusception. Endoscopy 2023; 55:E452-E453. [PMID: 36828015 PMCID: PMC9957672 DOI: 10.1055/a-2015-2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kotaro Shibagaki
- Department of Endoscopy, Shimane University Hospital, Izumo, Japan
| | - Chika Fukuyama
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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18
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Sperling G, Shatila M, Varatharajalu K, Lu Y, Altan M, Zhou Y, Zhao D, De Toni EN, Török HP, Schneider BJ, Khan A, Thomas AS, Zhang HC, Shafi MA, Wang Y. Pneumatosis intestinalis in cancer patients who received immune checkpoint inhibitors. J Cancer Res Clin Oncol 2023; 149:17597-17605. [PMID: 37917197 DOI: 10.1007/s00432-023-05461-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Immune checkpoint inhibitor (ICI) therapy may give rise to immune-related adverse events (irAEs). Pneumatosis intestinalis (PI), or gas within the bowel wall, has very rarely been observed following ICI therapy, and its clinical significance is unclear. We described the clinical characteristics and outcomes of PI as a possible irAE in cancer patients. METHODS We retrospectively identified 12 adult cancer patients with radiologic evidence of PI within 1 year after ICI exposure during January 2010-January 2023. Clinical characteristics, treatment, and outcomes were evaluated. RESULTS The median age of our sample was 64 years. The most common cancer types were thoracic/head & neck and gastrointestinal. Eleven patients (92%) received anti-PD-1/L1 monotherapy, while 1 patient (8%) received a combination of anti-PD-1/L1 and anti-CTLA-4. PI occurred a median of 7 months after the first ICI dose. Half the patients (50%) were asymptomatic on diagnosis, and the most common presenting symptom was abdominal pain (42%). Six patients experienced complications, namely pneumoperitoneum (n = 6, 50%) and microperforation (n = 1, 8%), identified on imaging. Nine patients were treated with antibiotics and 3 patients were monitored conservatively. Nine patients (75%) resumed cancer treatment after PI. CONCLUSION PI may develop as an irAE. While half of cases were incidental radiologic findings, management with antibiotics as well as hospitalization for observation may still be appropriate. The decision to restart cancer therapy and possibly resume ICI therapy remains to be elucidated. Further large-scale studies may be warranted to clarify the association between PI and ICI therapy.
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Affiliation(s)
- Gabriel Sperling
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Malek Shatila
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Krishnavathan Varatharajalu
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Yang Lu
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yan Zhou
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dan Zhao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Helga-Paula Török
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bryan J Schneider
- Department of Thoracic Medical Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - Anam Khan
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Anusha S Thomas
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Hao Chi Zhang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Mehnaz A Shafi
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA.
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Spencer BL, Aaron B, Imel S, Hirschl RB, Gadepalli SK. Non-Operative Management of Children with Pneumatosis Intestinalis Beyond the Neonatal Period: Opportunity to Decrease Resource Utilization, a Single Center Experience. J Gastrointest Surg 2023; 27:3074-3075. [PMID: 37670108 DOI: 10.1007/s11605-023-05828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Brianna L Spencer
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA.
| | - Bryan Aaron
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
| | - Sydni Imel
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
| | - Ronald B Hirschl
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
| | - Samir K Gadepalli
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, 1150 West Medical Center Dr. MSRB II B560, Ann Arbor, MI, USA
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Wang Y, Zhang B, Li L, Sun H, Chai N, Linghu E. Clinical and Endoscopic Features of Pneumatosis Cystoides Intestinalis: A Retrospective Study in 192 Patients. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:1116-1123. [PMID: 37823317 PMCID: PMC10724779 DOI: 10.5152/tjg.2023.22689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/16/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND/AIMS Pneumatosis cystoides intestinalis is not well recognized. Clinical features vary in several case reports, and prognosis remains unclear. We aimed to summarize the clinical and endoscopic features of pneumatosis cystoides intestinalis and to explore potential factors associated with lesion size. MATERIALS AND METHODS We retrospectively collected clinical and endoscopic features of patients diagnosed with pneumatosis cystoides intestinalis from July 2015 to October 2021. Patients were allocated to 2 groups according to lesion size with 2 cm as boundary value. Baseline characteristics were compared between the groups. RESULTS A total of 192 patients were included in this study with a 1.3:1 male-to-female ratio. About 91 lesions (47.70%) were ≥2 cm and those patients were more likely to have a history of polypectomy or abdominal surgery compared to lesion size <2 cm (P < .05). For 50 patients who received follow-up colonoscopy, 28 cases (56.00%) disappeared spontaneously and 22 cases (44.00%) remained unchanged. No factors have been observed to be connected with prognosis. CONCLUSIONS Colonoscopy is beneficial to the diagnosis of pneumatosis cystoides intestinalis. Patients with a history of polypectomy or abdominal surgery were more likely to develop lesions <2 cm. Most patients do not need special treatments and have favorable prognosis.
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Affiliation(s)
- Yan Wang
- Nankai University School of Medicine, Tianjin, China
- Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Bo Zhang
- Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Hongyi Sun
- Nankai University School of Medicine, Tianjin, China
- Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Nankai University School of Medicine, Tianjin, China
- Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China
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21
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Nureta TH, Moges TG, Abebe DM. Pneumatosis cystoides intestinalis associated with gastric outlet obstruction; A case report. Int J Surg Case Rep 2023; 111:108828. [PMID: 37716064 PMCID: PMC10509697 DOI: 10.1016/j.ijscr.2023.108828] [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: 08/11/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Pneumatosis cystoides intestinalis (PCI) is defined as the presence of air-filled cysts in the bowel wall. The overall incidence of pneumatosis cystoides intestinalis in the general population is very rare. PRESENTATION OF CASE This is a 44-year-old male patient who presented with epigastric abdominal pain and repeated vomiting of one-month duration. The patient was emaciated; vital signs were within normal limits. The abdomen was grossly distended. Laboratory tests, radiologic imaging, and upper gastrointestinal endoscopy were performed. The diagnosis of gastric outlet obstruction (GOO) secondary to peptic ulcer disease cicatrization along with the coincidental finding of PCI with hepato-diaphragmatic interposition of the small bowel (Chilaiditi sign) was made. Truncal vagotomy, gastrojejunostomy, and Braun jejunojejunostomy was performed. Adhesionolysis and repositioning of the ileum back into its' normal infracolic location was also done. CLINICAL DISCUSSION The causes of PCIs are multifactorial; however, the exact etiology is not well known. PCIs have a wide range of non-specific presenting symptoms such as bloody stools, diarrhea or constipation, vomiting, abdominal pain, flatulence, and weight loss. The diagnosis of PCI is made based on endoscopy and radiographic evaluation of the alimentary tract. The appropriate therapy depends on the underlying etiology and the presence of complications. CONCLUSION In the absence of complication, PCI can be managed conservatively. However, in the presence of an indication for surgery, PCI related with bowel interposition in the hepato-diaphragmatic space; concomitant repositioning and adhesion release may help to alleviate the symptoms and prevent further complication of PCI.
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Affiliation(s)
- Tilahun Habte Nureta
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia.
| | - Tadesse Girma Moges
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
| | - Dabessa Mossissa Abebe
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
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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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23
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Acker SN, Ogle S, Cooper EH, Kaizer AM, Kulungowski AM. What is the role of neutropenia in pediatric cancer patients with pneumatosis intestinalis? Pediatr Surg Int 2023; 39:203. [PMID: 37219695 DOI: 10.1007/s00383-023-05485-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND We aimed to identify prognostic indicators in pneumatosis intestinalis (PI) in a pediatric oncology population. We hypothesized that neutropenia would be an independent risk factor for adverse outcomes, including the need for abdominal operation to treat PI and for the development of recurrent PI. METHODS We performed a retrospective review of all patients treated for PI between 2009 and 2019 with a diagnosis of cancer or history of bone marrow transplant (BMT). RESULTS Sixty-eight children were treated for their first episode of PI; 15 (22%) were not neutropenic at presentation; eight underwent urgent abdominal operation (12%). Patients with neutropenia were more likely to receive TPN, had a longer course of NPO, and received a longer course of antibiotics. Neutropenia at presentation was associated with a decreased risk of PI recurrence (40% vs 13%, p = 0.03). Children who required an abdominal operation were more likely to require vasopressors at diagnosis (50% vs 10%, p = 0.013). CONCLUSIONS Among pediatric cancer patients, need for vasopressors at the time of PI is a marker of severe PI, with increased likelihood of requiring operative intervention. The presence of neutropenia is associated with lower rates of PI recurrence. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shannon N Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA.
- The Surgical Oncology Program at Children's Hospital Colorado, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
- Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Sarah Ogle
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Emily H Cooper
- Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander M Kaizer
- Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
- The Surgical Oncology Program at Children's Hospital Colorado, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
- Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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24
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Yvamoto EY, Cheng S, de Oliveira GHP, Sasso JGRJ, Boghossian MB, Minata MK, Ribeiro IB, de Moura EGH. Endoscopic Ultrasound View of Pneumatosis Cystoides Intestinalis. Diagnostics (Basel) 2023; 13:1424. [PMID: 37189527 PMCID: PMC10137753 DOI: 10.3390/diagnostics13081424] [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: 01/23/2023] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Pneumatosis cystoid intestinalis (PCI) is a rare condition, with a worldwide incidence of 0.3-1.2%. PCI is classified into primary (idiopathic) and secondary forms, with 15% and 85% of presentations, respectively. This pathology was associated with a wide variety of underlining etiologies to explain the abnormal accumulation of gas within the submucosa (69.9%), subserosa (25.5%), or both layers (4.6%). Many patients endure misdiagnosis, mistreatment, or even inadequate surgical exploration. In this case, a patient presented acute diverticulitis, after treatment, a control colonoscopy was performed that found multiple rounds and elevated lesions. To further study the subepithelial lesion (SEL), a colorectal endoscopic ultrasound (EUS) was performed with an overtube in the same procedure. For safe insertion of the curvilinear array EUS, an overtube with colonoscopy was positioned through the sigmoid as described by Cheng et al. The EUS evaluation evidenced air reverberation in the submucosal layer. The pathological analysis was consistent with PCI's diagnosis. The diagnosis of PCI is usually made by colonoscopy (51.9%), surgery (40.6%), and radiological findings (10.9%). Although the diagnosis can be made by radiological studies, a colorectal EUS and colonoscopy can be made in the same section without radiation and with high precision. As it is a rare disease, there are not enough studies to define the best approach, although colorectal EUS should be preferred for a reliable diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Igor Braga Ribeiro
- Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, SP, Brazil
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25
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Wang C, Zhang Y. Acarbose associated pneumatosis cystoides intestinalis: A case report. Int J Diabetes Dev Ctries 2023. [DOI: 10.1007/s13410-023-01191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
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Iio K, Hagiwara Y. Colocolic intussusception secondary to pneumatosis cystoides intestinalis: the role of abdominal radiography in the diagnosis. BMJ Case Rep 2022; 15:e252991. [PMID: 36521874 PMCID: PMC9756183 DOI: 10.1136/bcr-2022-252991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Kazuki Iio
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yusuke Hagiwara
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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Acker SN, Ogle S, Cooper E, Meier M, Peterson PN, Kulungowski AM. Current approaches to the management of pneumatosis intestinalis: an American Pediatric Surgical Association membership survey. Pediatr Surg Int 2022; 38:1965-1970. [PMID: 36242600 DOI: 10.1007/s00383-022-05249-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Pneumatosis intestinalis (PI) remains difficult to treat as it can lead to a broad range of clinical sequalae and there are little published data available to guide management. Our aim was to evaluate how pediatric surgeons currently manage children with PI, how treatment varies based on etiology, and to identify opportunities to optimize current PI management strategies. METHODS We administered a web-based survey of practicing pediatric surgeons in the United States and Canada. The survey was distributed to all members of the American Pediatric Surgical Association. RESULTS Of 1508 distributed surveys, 333 responses were received (22% response rate); 174 were complete and included in analysis (12% analyzed). For all scenarios, respondents recommended treatment for PI include a median 7 days of bowel rest and 7 days antibiotics. Only 41% reported their approach to PI management was optimal. Ways to optimize care include treatment based on etiology (83%), decreased number of repeat images (64%), shorter NPO course (49%), and shorter antibiotic course (47%). CONCLUSION Pediatric surgeons manage PI similarly regardless of etiology but most report this is suboptimal. Future work is needed to prospectively evaluate management protocols that consider etiology.
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Affiliation(s)
- Shannon N Acker
- Division of Pediatric Surgery, Anschutz Medical Campus, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Box 323, Aurora, CO, 80045, USA.
| | - Sarah Ogle
- Division of Pediatric Surgery, Anschutz Medical Campus, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Box 323, Aurora, CO, 80045, USA
| | - Emily Cooper
- Research Outcomes in Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Maxene Meier
- Research Outcomes in Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Pamela N Peterson
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA
- Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Anschutz Medical Campus, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Box 323, Aurora, CO, 80045, USA
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Peixoto A, Pereira R, Leitão J. Idiopathic pneumatosis cystoides coli: An uncommon cause of pneumoperitoneum. Radiol Case Rep 2022; 17:4408-4412. [PMID: 36188071 PMCID: PMC9520510 DOI: 10.1016/j.radcr.2022.08.067] [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] [Received: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare entity characterized by the presence of gaseous cystic within the intestinal wall. The primary or idiopathic type represents 15% of cases and is a self-limited or chronic benign entity. The secondary type represents 85% of cases and is associated with various factors, such as surgery, pharmacotherapy, chemotherapy, autoimmune diseases, inflammatory diseases, and pulmonary illness. Pneumatosis cystoides intestinalis affects the colon (pneumatosis cystoides coli) in about half of the cases. The differential diagnosis of PCI includes potentially life-threatening diseases that cause pneumatosis intestinalis. The misdiagnosis of PCI is common and can lead to unnecessary treatments and surgical procedures. We describe an asymptomatic pneumoperitoneum incidentally seen on chest radiograph. The cause was pneumatosis cystoides coli, which did not require treatment.
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Siljeström Berenguer C, Pérez Enciso I, Suárez-Ferrer C. Endoscopic imaging of pneumatosis intestinalis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:696-697. [PMID: 35770544 DOI: 10.17235/reed.2022.8972/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This is a case report on the colonoscopic finding of intestinal pneumatosis.
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The effect of single ventricle congenital heart disease on recurrence risk of pneumatosis intestinalis in neonates. Pediatr Surg Int 2022; 38:1399-1404. [PMID: 35852591 DOI: 10.1007/s00383-022-05171-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Congenital heart disease (CHD) is a risk factor for the development of pneumatosis intestinalis (PI). Patients with single ventricle physiology (SVP) may be at higher risk of developing PI secondary to variations in systemic blood flow which affect bowel perfusion when compared to patients with biventricular physiology (BVP). We hypothesized that patients with SVP would have increased risk of recurrent PI. METHODS A retrospective review was done from 10/2014 through 05/2020 with patients that met the following criteria: CHD, radiographic evidence of PI, and less than 1 year of age. Groups were divided based on ventricular physiology. Primary outcome was radiographic recurrence of PI and secondary outcomes were average antibiotic duration, NPO duration, median length of stay, need for GI operation, and death from PI. RESULTS A total of 51 patients were included, 34 with SVP and 17 with BVP. 26.47% of SVP had recurrence of PI whereas no BVP experienced a recurrence of PI. There was no significant difference in any of the secondary outcomes. CONCLUSION Our data suggest that patients with SVP are more likely to have recurrence of radiographic PI. We may need to consider patients with SVP that get PI as their own separate group.
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Hu SF, Liu HB, Hao YY. Portal vein gas combined with pneumatosis intestinalis and emphysematous cystitis: A case report and literature review. World J Clin Cases 2022; 10:8945-8953. [PMID: 36157643 PMCID: PMC9477024 DOI: 10.12998/wjcc.v10.i25.8945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/21/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Portal venous gas (PVG) is a rare clinical condition usually indicative of severe disorders, including necrotizing enterocolitis, bowel ischemia, or bowel wall rupture/infarction. Pneumatosis intestinalis (PI) is a rare illness characterized by an infiltration of gas into the intestinal wall. Emphysematous cystitis (EC) is relatively rare and characterized by intramural and/or intraluminal bladder gas best depicted by cross-sectional imaging. Our study reports a rare case coexistence of PVG presenting with PI and EC.
CASE SUMMARY An 86-year-old woman was admitted to the emergency room due to the progressive aggravation of pain because of abdominal fullness and distention, complicated with vomiting and stopping defecation for 4 d. The abdominal computed tomography (CT) plain scan indicated intestinal obstruction with ischemia changes, gas in the portal vein, left renal artery, superior mesenteric artery, superior mesenteric vein, some branch vessels, and bladder pneumatosis with air-fluid levels. Emergency surgery was conducted on the patient. Ischemic necrosis was found in the small intestine approximately 110 cm below the Treitz ligament and in the ileocecal junction and ascending colon canals. This included excision of the necrotic small intestine and right colon, fistulation of the proximal small intestine, and distal closure of the transverse colon. Subsequently, the patient displayed postoperative short bowel syndrome but had a good recovery. She received intravenous fluid infusion and enteral nutrition maintenance every other day after discharge from the community hospital.
CONCLUSION Emergency surgery should be performed when CT shows signs of PVG with PI and EC along with a clinical situation strongly suggestive of bowel ischemia.
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Affiliation(s)
- Shi-Fu Hu
- Department of General Surgery, Tianjin Xiqing Hospital, Tianjin 300100, China
| | - Han-Bo Liu
- Department of General Surgery, Tianjin Xiqing Hospital, Tianjin 300100, China
| | - Yuan-Yuan Hao
- Department of Geriatrics, Tianjin Xiqing Hospital, Tianjin 300100, China
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Ochi S, Sano N, Iga J, Ueno S. Takotsubo cardiomyopathy associated with pneumatosis cystoides intestinalis and postprandial hypoglycemia of anorexia nervosa. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e33. [PMID: 38868681 PMCID: PMC11114407 DOI: 10.1002/pcn5.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/17/2022] [Accepted: 06/26/2022] [Indexed: 06/14/2024]
Abstract
Hypoglycemia is not rare in anorexia nervosa (AN). Takotsubo cardiomyopathy (TCM) is characterized by extensive akinesis of the apical region with hypercontraction of the basal segment of the ventricle in the absence of coronary artery disease. Its mechanism is not fully understood, but hypoglycemia is considered one of the physical factors. Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gaseous cysts in the intestinal wall. PCI sometimes causes an absorption defect. The case of a 48-year-old woman with AN with PCI and TCM that developed after a postprandial hypoglycemic coma is reported. When the patient was admitted to our hospital, her abdominal X-ray showed a confluent image of grapes, and computed tomography showed gaseous cysts in the intestinal wall from the ascending colon to the transverse colon. PCI was then diagnosed. About 7 days after admission, she developed hypoglycemic coma. However, she recovered from the coma and on the next day she became suddenly hypotensive, with the electrocardiogram showing T-wave inversion. Echocardiography then showed akinesis around the apex and hypercontraction of the basal segments, and TCM was diagnosed. Severe AN with PCI may cause more severe hypoglycemia, resulting in TCM.
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Affiliation(s)
- Shinichiro Ochi
- Department of NeuropsychiatryEhime University Graduate School of Medicine, ToonEhimeJapan
- Present address:
Department of NeuropsychiatryEhime University Graduate School of Medicine, ShitsukawaToonEhimeJapan
| | | | - Jun‐ichi Iga
- Department of NeuropsychiatryEhime University Graduate School of Medicine, ToonEhimeJapan
| | - Shu‐ichi Ueno
- Department of NeuropsychiatryEhime University Graduate School of Medicine, ToonEhimeJapan
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Chihab M, Qadabashi K, Abbas H, Attar M, Aljaber A, Alabd M, Ayoub K. Acute abdomen with gastric volvulus revealing an underlying pneumatosis cystoides intestinalis: a case report. BMC Surg 2022; 22:267. [PMID: 35820895 PMCID: PMC9277939 DOI: 10.1186/s12893-022-01717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Pneumatosis intestinalis is an abnormal presence of free air outside the lumen of the intestines in many shapes. It is classified based on its etiology to primary or secondary, it affects adults as well as infants and can involve any part of the GI tract. Case presentation We report a case of a 55-year-old man with a past medical history of a surgically repaired perforated duodenal ulcer who presented with an acute abdominal pain, Flatulence and constipation. On examination of the abdomen; severe distension, tenderness and tympanicity on percussion were noted. An erect CXR was performed and showed bilateral sub-diaphragmatic air levels. We performed an abdominal Paracentesis under the right subcostal margin which led to evacuation of large amounts of air. Next, an investigational laparotomy showed that the reason was a gastric volvulus associated with an anterior and posterior gastric wall lacerations. The suitable surgical repair approach was taken, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) was extended along large length of the intestines in many shapes and without any symptoms or signs. Conclusions Pneumatosis cystoides intestinalis has been reported continuously in relation to peptic ulcer disease (PUD). We aim to report a new association of a gastric volvulus and PCI secondary to pyloric stenosis caused by a duodenal ulcer; which we believe can aid in the diagnosing of dangerous complications, of a rare disease.
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Affiliation(s)
- Mtanyous Chihab
- Department of Internal Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Khaled Qadabashi
- Department of Internal Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria.
| | - Huda Abbas
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Maysam Attar
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ahmad Aljaber
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Maden Alabd
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Kusay Ayoub
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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Aonuma K, Yamamoto Y, Tamada T, Ito Y, Noda K, Suzuki Y, Nakajima A. Pneumatosis Intestinalis Developed in a Patient with Giant Cell Arteritis While in a Clinically Sustained Remission Phase. Intern Med 2022; 61:2067-2072. [PMID: 34840228 PMCID: PMC9334237 DOI: 10.2169/internalmedicine.8402-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a patient with giant cell arteritis (GCA) who developed pneumatosis intestinalis (PI) while she was in a clinically sustained remission phase. A 79-year-old woman with GCA involving the thoracic aorta and its first branches to the posterior tibial arteries had been treated with high-dose prednisolone. Nine weeks after initiating treatment and while in clinically sustained remission with a normal CRP level, PI and pneumoperitoneum were incidentally found during scheduled positron emission tomography-computed tomography, which also revealed slight residual inflammation of GCA. This is a very rare case of PI complicated by GCA, and we discuss the possible relationships.
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Affiliation(s)
- Kaya Aonuma
- Center for Rheumatic Diseases, Mie University Hospital, Japan
| | | | - Tatsuya Tamada
- Center for Rheumatic Diseases, Mie University Hospital, Japan
| | - Yuhei Ito
- Center for Rheumatic Diseases, Mie University Hospital, Japan
| | - Kentaro Noda
- Center for Rheumatic Diseases, Mie University Hospital, Japan
| | - Yasuo Suzuki
- Center for Rheumatic Diseases, Mie University Hospital, Japan
| | - Ayako Nakajima
- Center for Rheumatic Diseases, Mie University Hospital, Japan
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35
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Chi WY, Su PH, Su YJ. An Elderly Woman with Life-Threatening Abdominal Pain. Am J Med 2022; 135:728-729. [PMID: 35139321 DOI: 10.1016/j.amjmed.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Wei-Yang Chi
- Department of Emergency Medicine, Tamshui Branch, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Po-Hua Su
- Department of Emergency Medicine, Tamshui Branch, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei City, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Mackay Junior College of Medicine, Nursing, and Management. Taipei, Taiwan; Yuanpei University of Medical Technology, HsinChu, Taiwan.
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36
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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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Lassandro G, Picchi SG, Romano F, Sica G, Lieto R, Bocchini G, Guarino S, Lassandro F. Intestinal pneumatosis: differential diagnosis. Abdom Radiol (NY) 2022; 47:1529-1540. [PMID: 32737548 DOI: 10.1007/s00261-020-02639-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/21/2020] [Accepted: 07/04/2020] [Indexed: 01/04/2023]
Abstract
Intestinal pneumatosis (IP) is an infrequent radiological sign defined as pathological gas infiltration into the bowel wall. It may be associated to different underlying clinical conditions-inflammatory bowel diseases, malignancies, chemotherapy, infections, immune deficiency status, trauma, intestinal ischemia, and necrosis-that are often related to emergency state and require a prompt diagnosis. All the imaging techniques, especially abdominal radiography and Computed Tomography, could detect the presence of IP and discern the forms related to emergency conditions. The differential diagnosis is essential to start an immediate clinical or surgical management and treatment. The aim of this article is to review the radiological features of IP in different illnesses, with particular attention to differential diagnosis.
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Affiliation(s)
- Giulia Lassandro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | | | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | - Roberta Lieto
- Department of Radiology, Monaldi Hospital, Naples, Italy
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Idiopathic Nonsurgical Pneumoperitoneum in Healthy Individuals after Endoscopy: Coincidence or Consequence? Case Rep Gastrointest Med 2022; 2022:7267657. [PMID: 35425647 PMCID: PMC9005272 DOI: 10.1155/2022/7267657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
Idiopathic pneumoperitoneum has an unknown etiology despite exploratory laparotomy. However, it may occur without definite abdominal symptoms; thus, adequate management could be in clinical dilemma. We experienced three cases of idiopathic nonsurgical pneumoperitoneum in healthy individuals during a health check-up. Their cases were not accompanied by any relevant etiology or definite abdominal symptoms. All of the three cases exhibited a benign clinical course. The three patients underwent an abdominal computed tomography (CT) scan as part of a health check-up program, which incidentally revealed free air in the right paracolic gutter without evidence of visceral perforation or inflammation. Among the three cases, two patients underwent colonoscopy before abdominal CT, whereas one patient did not. Two cases were completely asymptomatic and were observed without any treatment in the outpatient clinic. Only the third case with minimal symptoms was treated conservatively for a short time. If a small amount of free air typically located in the right paracolic gutter is detected in the absence of perforation during colonoscopy, close observation without unnecessary treatment would be sufficient.
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39
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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: 1.3] [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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40
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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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41
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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: 0.3] [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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42
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Laranjo A, Currais P, Veloso N, Faias S. Pneumatosis Cystoides Intestinalis: A Rare Cause of Gastrointestinal Hemorrhage. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:440-442. [PMID: 34901455 DOI: 10.1159/000512529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ana Laranjo
- Department of Gastroenterology, Hospital Espírito Santo de Évora, Évora, Portugal
| | - Pedro Currais
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Nuno Veloso
- Department of Gastroenterology, Hospital Espírito Santo de Évora, Évora, Portugal
| | - Sandra Faias
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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43
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Arman Bilir Ö, Demir AM, Akçabelen YM, Ok Bozkaya İ, Gürlek Gökçebay D, Güneş A, Özbek NY, Yaralı N. Pneumatosis cystoides intestinalis: A rare complication after hematopoietic stem cell transplantation. Pediatr Transplant 2021; 25:e14136. [PMID: 34505744 DOI: 10.1111/petr.14136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/03/2021] [Accepted: 08/25/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pneumatosis cystoides intestinalis (PCI) is a disorder in which widespread air sacs are present in mucosa, submucosa, subserosa, and intraabdominal area of the intestinal wall. It has a heterogeneous clinical presentation as a rare complication of intestinal graft-versus-host disease (GVHD). Computed tomography is the preferred imaging method for the diagnosis. Since the air sacs could be ruptured spontaneously, the presence of free air in the peritoneal cavity does not confirm intestinal perforation. The conservative treatment approach is sufficient in cases that do not require urgent surgical intervention, such as perforation or obstruction. CASE Here, we present a 2.5-year-old patient diagnosed with primary hemophagocytic lymphohistiocytosis (pHLH), who underwent allogeneic hematopoietic stem cell transplantation from a matched unrelated donor (MUD) and developed PCI secondary to intestinal GVHD 14th months after HSCT. CONCLUSIONS Pneumatosis cystoides intestinalis, which is a rare complication, should be kept in mind, especially in patients with intestinal GVHD and receiving intensive immunosuppressive, octreotide, and steroid treatment after HSCT.
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Affiliation(s)
- Özlem Arman Bilir
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yunus Murat Akçabelen
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Gürlek Gökçebay
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Altan Güneş
- Department of Pediatric Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Acker SN, Ogle S, Saifee J, Marks L, Kulungowski AM. Surgical management of recurrent idiopathic pneumatosis intestinalis in the pediatric population. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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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.73042.1] [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: 11/21/2022] [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 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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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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Della Seta M, Kloeckner R, Pinto Dos Santos D, Walter-Rittel TC, Hahn F, Henze J, Gropp A, Pratschke J, Hamm B, Geisel D, Auer TA. Pneumatosis intestinalis and porto-mesenteric venous gas: a multicenter study. BMC Med Imaging 2021; 21:129. [PMID: 34429069 PMCID: PMC8383372 DOI: 10.1186/s12880-021-00651-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine. METHODS A total of 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis). RESULTS Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p < 0.001). In the entire patient group, 53.5% (155/290) were treated surgically with a 90d mortality of 58.8% (91/155) in this latter group, while 90d mortality was 51.1% (69/135) in patients treated conservatively. In the patients who survived > 90d treated conservatively (24.9% of the entire collective; 72/290) PMVG/PI was defined as "benign"/reversible. PMVG, COPD, sepsis and a low platelet count were found to correlate with a worse prognosis helping to identify patients who might not profit from surgery, in this context our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV. CONCLUSION Although PI is associated with high morbidity and mortality, "benign causes" are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.
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Affiliation(s)
- Marta Della Seta
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Roman Kloeckner
- Department for Radiology, University Hospital Mainz, Mainz, Germany
| | | | - Thula Cannon Walter-Rittel
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Hahn
- Department for Radiology, University Hospital Mainz, Mainz, Germany
| | - Jörn Henze
- Department for Radiology, University Hospital of Cologne, Cologne, Germany
| | - Annika Gropp
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplant Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernd Hamm
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Timo Alexander Auer
- Department for Radiology, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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48
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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: 0.5] [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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Iinuma S, Takahashi C, Oba M, Ishida-Yamamoto A. Pneumatosis intestinalis during treatment for bullous pemphigoid. Int J Dermatol 2021; 61:e131-e132. [PMID: 34151430 DOI: 10.1111/ijd.15713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shin Iinuma
- Department of Dermatology, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Chiaki Takahashi
- Department of Dermatology, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Mitsunobu Oba
- Department of Surgery, Japanese Red Cross Kitami Hospital, Kitami, Japan
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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: 1.0] [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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