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Primary Pneumotosis Cystoides Intestinalis  [PDF]
Chun-Hsiung Liu,Hong Haw Chen,Wan-Ting Huang
Chang Gung Medical Journal , 2003,
Abstract: We describe an unusual case of pneumatosis cystoides intestinalis (PCI) in a patientwith chronic pulmonary disease. A 79-year-old woman was hospitalized due to abdominalfullness and bowel habit change. Colonoscopy revealed numerous round cystic lesions in thesigmoid colon, which bled easily on contact. Due to persistent local peritonitis, a left hemicolectomywith primary anastomosis was performed. The patient has done well in the 12months following surgery
Pneumatosis Intestinalis: Not Always a Surgical Indication  [PDF]
Haijing Zhang,Stephanie L. Jun,Todd V. Brennan
Case Reports in Surgery , 2012, DOI: 10.1155/2012/719713
Abstract: We present a case of pneumatosis intestinalis (PI) of the colon in the setting of inflammatory bowel disease that was treated with medical management rather than emergent surgery. While the reflex response to extraluminal air in the abdomen is abdominal exploration, consideration of the clinical context in which PI is discovered and an understanding of a complete differential diagnosis of the sources of PI is critical to avoiding unnecessary surgery. 1. Introduction Pneumatosis intestinalis (PI), also referred to as pneumatosis cystoides intestinalis, pneumatosis coli, and intestinal emphysema, is defined as the presence of extraluminal bowel gas that is confined within the bowel wall. The small intestine (42%) is most commonly involved followed by colon (36%), with involvement of both in 22% [1]. PI is an alarming radiological finding that usually prompts an emergent surgical consultation for concerns of bowel ischemia and impending bowel rupture. However, there is a wide spectrum of causes of PI ranging from the benign to the life-threatening. PI may be caused by bowel ischemia, mechanical trauma, inflammatory/autoimmune bowel disease, intestinal neoplasms, bowel infection, obstructive pulmonary disease, or drug-induced, including immunosuppression, therapy [1, 2]. Differentiating these causes is critical in directing an appropriate care plan. Complications are present in 3% of PI patients and include pneumoperitoneum, bowel obstruction, volvulus, intussusception, and hemorrhage [3]. Due to the risk of these emergent complications, suspected PI patients should be carefully evaluated for possible surgery. In a prospective review of patients with PI, bowel necrosis requiring surgery was predicted by 5 findings: an acute abdomen per history and physical, metabolic acidosis ( ,?? ), elevated lactate, elevated serum amylase, and presence of portal venous gas [4]. For symptomatic PI of mild-to-moderate severity, treatment of the underlying disease with administration of antibiotics, oxygen therapy, and elemental diet may be sufficient for PI resolution. Here we describe an elderly patient with benign PI in the setting of inflammatory bowel disease. 2. Case Presentation A 60-year-old man was admitted for a flare of Crohn’s disease, with pancolitis confirmed by colonoscopy with biopsy. He was discharged on oral prednisone, but was readmitted one week later for persistent abdominal pain, diarrhea, and a low-grade fever (38.1°C). A computed tomography (CT) scan of the abdomen on readmission showed thickening of the transverse, descending, and sigmoid colon. The
Pneumatosis Intestinalis: Autopsy Finding
Behnoush Behnam,Bazmi Shabnam,Mohammadi Firozeh,Bazmi Elham
Acta Medica Iranica , 2009,
Abstract: This is a case of a patient with bowel obstruction , imaging studies were suggestive for pneumatosis intestinalis. Clinically diagnosed as adhesion band and pnematosis intestinalis. She underwent laparatomy, enterolysis, obstructionolysis and enterorrhaphy. The patient developed respiratory distress and expired after 2 days. At autopsy we found gray-brown discoloration in the wall of some part of small bowel and flattening of mucus membrane. Grossly multiple gas-filled cysts were seen at the serosal surface. Microscopic evaluation of small intestine wall showed multiple cysts located in submucosal and serosal layers.
Pneumatosis intestinalis versus pseudo-pneumatosis: review of CT findings and differentiation
Jin Hong Wang,Alessandro Furlan,Diana Kaya,Satoshi Goshima,Mitchell Tublin,Kyongtae T. Bae
Insights into Imaging , 2011, DOI: 10.1007/s13244-010-0055-2
Abstract: Pneumatosis intestinalis is defined as the presence of gas within the wall of the gastrointestinal tract. Originally described on plain abdominal radiographs, it is an imaging sign rather than a specific diagnosis and it is associated with both benign and life-threatening clinical conditions. The most common life-threatening cause of pneumatosis intestinalis is bowel ischaemia. Computed tomography (CT) is usually requested to detect underlying disease. The presence of pneumatosis intestinalis often leads physicians to make a diagnosis of serious disease. However, an erroneous diagnosis of pneumatosis intestinalis may be made (i.e. pseudo-pneumatosis) when intraluminal beads of gas are trapped within or between faeces and adjacent mucosal folds. The purpose of this pictorial essay is to review and describe the CT imaging findings of pneumatosis and pseudo-pneumatosis intestinalis and to discuss key discriminatory imaging features.
Computed tomography colonography imaging of pneumatosis intestinalis after hyperbaric oxygen therapy: a case report
Jean-Louis Frossard, Philippe Braude, Jean-Yves Berney
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-375
Abstract: The present report describes the case of a 56-year-old Swiss-born man with symptomatic pneumatosis intestinalis resistant to all treatment except hyperbaric oxygen therapy, as showed by computed tomography colonography images performed before, during and after treatment.The current case describes the response to hyperbaric oxygen therapy using virtual colonoscopy technique one month and three months after treatment. Moreover, after six months of follow-up, there has been no recurrence of digestive symptoms.Pneumatosis intestinalis (PI) is a condition in which submucosal or subserosal gas cysts are found in the wall of the small or large bowel [1]. PI may affect any segment of the gastrointestinal tract. The pathogenesis of PI is not understood but many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical and bacterial causes [2]. Whatever the pathogenesis, gas forming bacteria gain access to the submucosa through breaches in the mucosa and, once inside the bowel wall, gas may spread along the bowel and mesentery to remote sites. In most cases PI is an incidental finding, whereas in others PI is secondary to a wide variety of gastrointestinal and non-gastrointestinal diseases [3,4]. The true incidence of PI is not known but it is increasingly reported because of the more frequent use and improvement in imaging modalities. PI can be seen at any age but usually affects patients > 50 years old. PI usually remains asymptomatic in most cases but may clinically present in a benign form or less frequently in fulminant forms, the latter condition being associated with an acute bacterial process, sepsis, and necrosis of the bowel [1]. Symptoms include abdominal distension, abdominal pain, diarrhea, constipation and flatulence, all symptoms that may lead to an erroneous diagnosis of irritable bowel syndrome [5]. Complications of PI such as bowel obstruction, volvulus, pneumoperitoneum and hemorrhage occur in about 3% of patients [1].
A Patient Suffering from Pneumatosis Cystoid Intestinalis  [cached]
Mahmoud Aghaei-Afshar,Foroogh Mangeli
Zahedan Journal of Research in Medical Sciences , 2012,
Abstract: Pneumatosis Cystoid Intestinalis (PCI) is a relatively rare disorder that occurs in different parts of the stomach and intestines as gas-filled cysts. It is predicted to be prevalent among 0/2- 0/03% of the population. In 85% of cases, Pneumatosis Cystoid Intestinalis is caused by a specific disease. In this article, a patient will be introduced who was admitted 3 days after the pelvic trauma presented with symptoms of intestinal obstruction. The conducted examinations showed generalized abdominal tenderness and in CXR plenty of free air was observed under the diaphragm. After the primary diagnosis of intestinal obstruction (ileus), the patient was put under laparotomy. During laparotomy, PCI was seen under the intestinal serosa and a significant amount of air was released and many parts of contusion were observed in the small intestine along with fibrin formation without pus which was restored and the patient was discharged in a well general condition.
Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis
PN Khalil, S Huber-Wagner, R Ladurner, A Kleespies, M Siebeck, W Mutschler, K Hallfeldt, K-G Kanz
European Journal of Medical Research , 2009, DOI: 10.1186/2047-783x-14-6-231
Abstract: The spectrum of pneumatosis intestinalis is discussed here based on various computed tomographic and surgical findings in patients who presented at our University Medical Centre in 2003-2008. We have also systematically reviewed the literature to establish the current understanding of its aetiology and pathophysiology, and the possible clinical conditions associated with pneumatosis intestinalis and their management.Pneumatosis intestinalis is a primary radiographic finding. After its diagnosis, its specific pathogenesis should be ascertained because the appropriate therapy is related to the underlying cause of pneumatosis intestinalis, and this is sometimes difficult to define. Surgical treatment should be considered urgent in symptomatic patients presenting with an acute abdomen, signs of ischemia, or bowel obstruction. In asymptomatic patients with otherwise inconspicuous findings, the underlying disease should be treated first, rather than urgent exploratory surgery considered. Extensive and comprehensive information on the pathophysiology and clinical findings of pneumatosis intestinalis is provided here and is incorporated into a treatment algorithm.The information presented here allows a better understanding of the radiographic diagnosis and underlying aetiology of pneumatosis intestinalis, and may facilitate the decision-making process in this context, thus providing fast and adequate therapy to particular patients.Pneumatosis intestinalis is an imaging phenomenon representing the presence of gas in the bowel wall. It was first recognized by DuVernoi in 1730 during a cadaver dissection, and there have since been numerous reports of various underlying diseases [1-7]. Pneumatosis intestinalis was defined as a radiographic diagnosis by Lerner and Gazin as early as 1946 [8]. The clinical relevance of pneumatosis intestinalis varies widely and ranges from benign to life-threatening conditions depending on the underlying cause of pneumatosis intestinalis [4,7]. Th
Pneumatosis Intestinalis: Not Always a Surgical Indication
Haijing Zhang,Stephanie L. Jun,Todd V. Brennan
Case Reports in Surgery , 2012, DOI: 10.1155/2012/719713
Abstract: We present a case of pneumatosis intestinalis (PI) of the colon in the setting of inflammatory bowel disease that was treated with medical management rather than emergent surgery. While the reflex response to extraluminal air in the abdomen is abdominal exploration, consideration of the clinical context in which PI is discovered and an understanding of a complete differential diagnosis of the sources of PI is critical to avoiding unnecessary surgery.
Pneumatosis Coli: A Case Report
Abdolrahim Nahidi,Alireza Rezaee
Jundishapur Scientific Medical Journal , 2012,
Abstract: Pneumatosis intestinalis isusuallya is a benign condition which may affect any segment of gastrointestinal tract from stomach to rectum. It is also called pneumatosis cystoides intestinalis (PCI). It is best classified into(A) a primary form and (B) a secondary form. Air cysts are found mostly in subserosa of large bowel. The aim of this study is to present 72-year–old heavy smoker man that referred to emergency department with abdominal pain, nausea, vomiting and decreased appetite for a period of three days duration. With impression of peritonitis due to hallow viscus perforation, as result the patient underwent laparotomy. Abdomen was completely cleaned without any puss or fluid. There were multiple gas-containing cysts over the antimesentric colonic wall of the transverse and sigmoid colon. We terminated the operation without any intervention. The patient became symptom free post operatively and discharged from hospital with good condition.
Three Cases of Pnematosis Cystoid Intestinalis with Different Manifestations
MK Amirbaigy,R Sami
Journal of Shahid Sadoughi University of Medical Sciences , 2007,
Abstract: Pneumatosis cystoides intestinalis (PCI) is a rare condition charachterized by the presence of multiple gases filled cysts in the gastro intestinal tract. In this article we present three cases with different features, Who at the end evaluation PCI was diagnosed. The first patient present with rectorrhagia (submucosal PCI). The second patient present with dyspepsia (subserosal intestinal PCI) and the third patient present with gastric outlet obstruction (subserosal gastric & intestinal PCI).
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