Pneumatosis cystoides intestinalis induced by the alpha-glucosidase inhibitor complicated from sigmoid volvulus in a diabetic patient

Clinical features of pneumatosis intestinalis induced by alpha- glucosidase inhibitor in patients with type 2 diabetes mellitus: a single center retrospective study

Purpose

Pneumatosis intestinalis (PI) is a rare but significant side effect associated with the use of alpha-glucosidase inhibitor (αGI) in the treatment of diabetes. This study aims to analyze the clinical features of PI induced by αGIs in patients with type 2 diabetes mellitus.

Methods

We conducted a retrospective analysis of patients diagnosed with PI between January 2018 and December 2023. Data collected included demographic characteristics, clinical symptoms and signs, laboratory findings, imaging results, endoscopic manifestations, treatments, and outcomes. Clinical characteristics were compared between patients who used acarbose and those who did not.

Results

A total of 48 patients with PI were included in the study, of whom 22 had used acarbose and 26 had not. The acarbose taken group was significantly older than the acarbose untaken group. Additionally, the prevalence of coronary heart disease and hypertension was markedly higher in patients taking acarbose. Importantly, total bilirubin levels were lower in those with PI who were on acarbose therapy.

Conclusion

Our findings highlight the need for increased vigilance regarding the potential development of PI in older diabetic patients with cardiovascular conditions following αGI administration. Timely intervention is crucial to prevent adverse outcomes. This study offers valuable insights for the future management of αGI in diabetes treatment.

The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review

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.

Exosomes Derived from Bone Marrow-Derived Mesenchymal Stem Cells (BM-MSC) Protect Submandibular Glands in Diabetic Rats

Our study assess whether exosomes derived from bone marrow mesenchymal stem cells (BM-MSC) ameliorates diabetic salivary gland complications. 10 SD rats were assigned into diabetes group I and exosome treatment group II. Diabetic rats were induced by streptozotocin (STZ) and injected with DMSO or exosomes through tail vein followed by collection of submandibular salivary gland samples for histological analysis and TGFβ, Smad2 and Smad3 level by PCR, saliva IgA and serum amylase level. Compared with control mice, exosome treatment mice showed less fibrosis of the submandibular salivary glands and duct components with a more complete structure. Exosome treatment inhibited TGFβ, Smad2 and Smad3 level to reduce diabetic salivary gland complications, effectively decreased blood sugar level, improved salivary glands function with significantly reduced serum amylase and salivary IgA levels. In conclusion, BM-MSC-derived exosomes may be a new therapeutic strategy for treating diabetic salivary gland complications.

Pneumatosis Intestinalis and Hepatic Portal Venous Gas: Watch and Wait or Emergency Surgery? A Case Report and Literature Review

Patient: Female, 60-year-old

Final Diagnosis: Pneumatosis intestinalis

Symptoms: Abdominal pain

Medication:—

Clinical Procedure: —

Specialty: Surgery