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Yuan JJ, Zhang HF, Zhang J, Li JZ. Mesenteric venous thrombosis in a young adult: A case report and review of the literature. World J Radiol 2024; 16:569-578. [PMID: 39494142 PMCID: PMC11525824 DOI: 10.4329/wjr.v16.i10.569] [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: 05/14/2024] [Revised: 08/22/2024] [Accepted: 09/06/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Acute mesenteric vein thrombosis (MVT) accounts for only 2%-10% of all cases of acute mesenteric ischaemia, with an incidence rate of ~0.1% in Europe and the United States. It represents < 10% of mesenteric infarction cases and is seen predominantly in older adults. In younger individuals, MVT is uncommon, with 36% of cases having unidentified mechanisms and causes. CASE SUMMARY A 27-year-old man presented to the emergency department on February 29, 2024, with a chief complaint of intermittent abdominal pain for 3 day. He was previously in good health. As the abdominal pain was not alleviated by conventional treatment, an abdominal computed tomography (CT) scan was performed, which showed increased density in the portal and mesenteric veins. Further imaging, including portal vein ultrasound, mesenteric CT angiography, and enhanced abdominal CT, revealed widespread thrombosis of the portal vein system (including the main portal vein, left and right branches, proximal mesenteric vein, and splenic vein). After 10 day of thrombectomy and anticoagulation therapy, the patient's abdominal pain had improved significantly. Follow-up assessments indicated that portal venous blood flow had largely returned to normal. He was discharged on March 9, 2024. During a follow-up exam 2 months later, repeat abdominal enhanced CT showed that the previously detected thrombi were no longer visible. CONCLUSION Clinicians should remain vigilant for acute MVT in young patients presenting with abdominal pain, to prevent misdiagnosis of this fatal condition.
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Affiliation(s)
- Jiao-Jiao Yuan
- Department of Emergency Medicine, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
| | - Hai-Fu Zhang
- Department of Vascular Intervention, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
| | - Jian Zhang
- Department of Emergency Medicine, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
| | - Jun-Zhi Li
- Department of Emergency Medicine, Ninth Hospital of Xi'an, Xi’an 710000, Shaanxi Province, China
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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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Pirola L, Palermo A, Mulinacci G, Ratti L, Fichera M, Invernizzi P, Viganò C, Massironi S. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg 2021; 13:702-716. [PMID: 34354803 PMCID: PMC8316849 DOI: 10.4240/wjgs.v13.i7.702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common. AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies. METHODS Bibliographical searches were performed in PubMed, using the following keywords: "COVID-19" AND "imaging" AND "gastrointestinal" OR "abdominal" OR "small bowel". RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman. CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.
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Affiliation(s)
- Lorena Pirola
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Giacomo Mulinacci
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Laura Ratti
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
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4
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El Hattabi K, Lafkih O, Bensardi F, Elbakouri A, Bouali M, Fadil A. Pneumatosis cystoides intestinalis with pneumoperitoneum secondary to stenosing pyloro-duodenal peptic ulcer: Case series of three patients and literature review. Int J Surg Case Rep 2021; 81:105772. [PMID: 33743257 PMCID: PMC8010462 DOI: 10.1016/j.ijscr.2021.105772] [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: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare condition which can be associated to pneumoperitoneum without gastro-intestinal perforation. PCI is most often secondary to various diseases and the stenosing peptic ulcer is one of them. Careful correlation of the clinical presentation with corroborating biological tests should determine whether a conservative medical approach or emergency surgical exploration is appropriate. Knowledge of this pathology is important to avoid unnecessary exploratory laparotomy. Introduction Pneumatosis cystoides intestinalis (PCI) is a rare condition, which can affect the entire gastro-intestinal tract. It can be idiopathic or most often secondary to various diseases. The causes remain multiple and the stenosing peptic ulcer is one of them. We report three case reports of pneumatosis cystoides with pneumoperitoneum intestinalis secondary to stenosing pyloro-duodenal peptic ulcer. Case presentation We report a case series of three patients with PCI that presented to the emergency department with a reassuring clinical picture with the discovery in imaging of a pneumoperitoneum. All our patients presented with a pyloro-duodenal stenosis secondary to a complicated peptic ulcer, one of which was treated surgically and the other two endoscopically. Discussion The objective of this report is to provide an update on pneumatosis cystoides intestinalis secondary to stenosing pyloro-duodenal peptic ulcer, by specifying its etiopathogenic, diagnostic and therapeutic characteristics. Conclusion Knowledge of this pathology is necessary in order to avoid unnecessary abusive surgery.
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Affiliation(s)
- Khalid El Hattabi
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Oussama Lafkih
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Fatimazahra Bensardi
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abdelilah Elbakouri
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mounir Bouali
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abdelaziz Fadil
- Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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5
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Kielty J, Duggan WP, O'Dwyer M. Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2. Ann R Coll Surg Engl 2020; 102:e145-e147. [PMID: 32538098 DOI: 10.1308/rcsann.2020.0145] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We present the case of a critically ill 47-year-old man diagnosed with SARS-CoV-2 (COVID-19) who developed extensive pneumatosis intestinalis and portal venous gas in conjunction with an acute abdomen during the recovery phase of his acute lung injury. A non-surgical conservative approach was taken as the definitive surgical procedure; a complete small-bowel resection was deemed to be associated with an unacceptably high long-term morbidity. However, repeat computed tomography four days later showed complete resolution of the original computed tomography findings. Pneumatosis intestinalis from non-ischaemic origins has been described in association with norovirus and cytomegalovirus. To our knowledge, this is the first time that this has been described in COVID-19.
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Affiliation(s)
- J Kielty
- Department of Anaesthesiology and Critical Care, St Vincent's University Hospital, Dublin, Ireland
| | - W P Duggan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - M O'Dwyer
- Department of Anaesthesiology and Critical Care, St Vincent's University Hospital, Dublin, Ireland
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6
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Abstract
Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.
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7
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Di Pietropaolo M, Trinci M, Giangregorio C, Galluzzo M, Miele V. Pneumatosis cystoides intestinalis: case report and review of literature. Clin J Gastroenterol 2019; 13:31-36. [PMID: 31161540 DOI: 10.1007/s12328-019-00999-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022]
Abstract
Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.
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Affiliation(s)
- Marco Di Pietropaolo
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy.
| | - Margherita Trinci
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Carlo Giangregorio
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, L. go Giovanni Alessandro Brambilla 3, 50134, Florence, Italy
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8
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Tseng SM, Li C, Ho CM. Pneumatosis cystoides intestinalis: Not uncommon cause of free air in acute abdomen. J Visc Surg 2019; 156:177-178. [PMID: 30249430 DOI: 10.1016/j.jviscsurg.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pneumatosis cystoides intestinalis is generally benign in course and sometimes, if cysts ruptured, behave as the not uncommon cause of free air in acute abdomen. In our case, we illustrate ruptured isolated cysts of pneumatosis cystoides intestinalis are responsible for pneumoperitoneum in a 94-year-old male patient. Laparotomy with gastrotomy for decompression of intraluminal aeropressure was performed, with an uneventful recovery. This paper presents with preoperative and intraoperative images of high educational value for this, often underdiagnosed, clinical entity.
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Affiliation(s)
- S-M Tseng
- Departments of Surgery, National Taiwan University Hospital, No.7 Chung-Shan South Road, Taipei 100, Taiwan
| | - C Li
- Departments of Surgery, National Taiwan University Hospital, No.7 Chung-Shan South Road, Taipei 100, Taiwan; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - C-M Ho
- Departments of Surgery, National Taiwan University Hospital, No.7 Chung-Shan South Road, Taipei 100, Taiwan.
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9
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Singh G, Johnson C, Gill R, De Cruz P. Pneumatosis cystoides intestinalis (PCI) in a patient with undiagnosed systemic sclerosis. BMJ Case Rep 2018; 2018:bcr-2018-225175. [PMID: 30269087 DOI: 10.1136/bcr-2018-225175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) refers to the presence of gas within the wall of the small or large intestine. The pathophysiology is incompletely understood and is probably multifactorial in nature. PCI is a known but rare complication of systemic scleroderma, and the aetiology of PCI in patients with scleroderma is not fully understood. We present the case of a patient who was referred to gastroenterology clinic by her general practitioner for investigation of 8 months of weight loss, urgency, diarrhoea, bloating and crampy abdominal pain. Extensive investigations were performed to exclude infective, inflammatory or malignant aetiologies for these symptoms. She was diagnosed with PCI on her colonoscopy and was subsequently screened for secondary causes. Our patient was diagnosed with the limited cutaneous (CREST) variant of systemic scleroderma. This case report illustrates that PCI could be an uncommon presentation of systemic sclerosis, therefore clinicians should be aware of the association between these conditions.
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Affiliation(s)
- Gurpreet Singh
- Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Christopher Johnson
- Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rosie Gill
- Department of Rheumatology, Austin Hospital, Melbourne, Victoria, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia
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Koysombat K, Capanna MV, Stafford N, Orchard T. Combination therapy for systemic sclerosis-associated pneumatosis intestinalis. BMJ Case Rep 2018; 2018:bcr-2018-225068. [PMID: 30002210 DOI: 10.1136/bcr-2018-225068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.
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Affiliation(s)
- Kanyada Koysombat
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Nina Stafford
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Orchard
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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11
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Koysombat K, Capanna MV, Stafford N, Orchard T. Combination therapy for systemic sclerosis-associated pneumatosis intestinalis. BMJ Case Rep 2018. [PMID: 30002210 DOI: 10.1136/bcr-2018–225068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.
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Affiliation(s)
- Kanyada Koysombat
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Nina Stafford
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Orchard
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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12
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Wang YJ, Wang YM, Zheng YM, Jiang HQ, Zhang J. Pneumatosis cystoides intestinalis: six case reports and a review of the literature. BMC Gastroenterol 2018; 18:100. [PMID: 29954324 PMCID: PMC6022295 DOI: 10.1186/s12876-018-0794-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 05/03/2018] [Indexed: 01/05/2023] Open
Abstract
Background Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts in the intestinal submucosa and subserosa. There are few reports of PCI occurring in duodenum and rectum. Here we demonstrated four different endoscopic manifestations of PCI and three cases with intestinal stricture all were successfully managed by medical conservative treatment. Case presentation There are 6 cases of PCI with varied causes encountered, in which the etiology, endoscopic features, treatment methods and prognosis of patients were studied. One case was idiopathic, while the other one case was caused by exposing to trichloroethylene (TCE), and the remaining four cases were secondary to diabetes, emphysema, therioma and diseases of immune system. Of the six patients, all complained of abdominal distention or diarrhea, three (50%) reported muco-bloody stools, two (33.3%) complained of abdominal pain. In four other patients, PCI occurred in the colon, especially the sigmoid colon, while in the other two patients, it occurred in duodenum and rectum. Endoscopic findings were divided into bubble-like pattern, grape or beaded circular forms, linear or cobblestone gas formation and irregular forms. After combination of medicine and endoscopic treatment, the symptoms of five patients were relieved, while one patient died of malignant tumors. Conclusion PCI endoscopic manifestations were varied, and radiology combined with endoscopy can avoid misdiagnosis. The primary bubble-like pattern can be cured by endoscopic resection, while removal of etiology combined with drug therapy can resolve majority of secondary cases, thereby avoiding the adverse risks of surgery.
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Affiliation(s)
- Yong Juan Wang
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Hebei Medical University, Hebei, China
| | - Yu Ming Wang
- Department of Gastroenterology and Hepatology, The General Hospital of Tianjin Medical University, Tianjin, China
| | - Yan Min Zheng
- Department of Gastroenterology and Hepatology, The General Hospital of Tianjin Medical University, Tianjin, China
| | - Hui Qing Jiang
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Hebei Medical University, Hebei, China
| | - Jie Zhang
- Department of Gastroenterology and Hepatology, The General Hospital of Tianjin Medical University, Tianjin, China.
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Abstract
Pneumoperitoneum is often associated with surgical complications or intra-abdominal sepsis. While commonly deemed a surgical emergency, pneumoperitoneum in a minority of cases does not involve a viscus perforation or require urgent surgical management; these cases of “spontaneous pneumoperitoneum” can stem from a variety of etiologies. We report a case of a 72-year-old African American male with a history of metastatic pancreatic adenocarcinoma who presented with new-onset abdominal distention and an incidentally discovered massive pneumoperitoneum with no clear source of perforation on surveillance imaging. His exam was non-peritonitic, so no surgical intervention was recommended. He was treated with bowel rest, intravenous antibiotics, and hydration. He had a relatively benign clinical course with preserved gastrointestinal function and had complete resolution of his pneumoperitoneum on imaging two months after discharge. This case highlights the importance of considering non-surgical causes of pneumoperitoneum, as well as conservative management, when approaching patients with otherwise benign abdominal exams.
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Affiliation(s)
- Harry Wang
- Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - Vivek Batra
- Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, USA
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14
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Blair HA, Baker R, Albazaz R. Pneumatosis intestinalis an increasingly common radiological finding, benign or life-threatening? A case series. BMJ Case Rep 2015; 2015:bcr-2014-207234. [PMID: 25694632 DOI: 10.1136/bcr-2014-207234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This case series reviews two cases where elderly patients were found to have pneumatosis intestinalis on imaging. The two clinical presentations differed from one another, however, both were managed conservatively to good effect. In case one the patient presented with abdominal pain, a change in bowel habit and weight loss. In case two the patient presented with problematic diarrhoea, reduced oral intake, lethargy and weight loss. Both patients were haemodynamically stable and neither had an abnormal abdominal examination. Case 2 was started on oral metronidazole and by day 11 of treatment there was resolution of the pneumatosis on her abdominal X-ray and her diarrhoea had settled. These two cases illustrate the benefit of conservative management and avoidance of unnecessary surgical intervention in primary pneumatosis intestinalis. However, it is important to distinguish between these benign causes of pneumatosis intestinalis and those which are life-threatening in which surgery may be necessary.
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Affiliation(s)
| | - Richard Baker
- John Goligher Colorectal Unit, St James University Hospital, Leeds, UK
| | - Raneem Albazaz
- Department of Radiology, St James University hospital, Leeds, UK
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