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You SS, Lin ZN, Sheng LX, Lai YL. Acute lymphoblastic leukemia with pneumatosis cystoides intestinalis after hematopoietic stem cell transplantation: a case report. J Int Med Res 2024; 52:3000605241274581. [PMID: 39246070 PMCID: PMC11382223 DOI: 10.1177/03000605241274581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by air accumulation within the subserosa or submucosa of the gastrointestinal wall. We herein report a case involving a woman in her early 30s who developed PCI after undergoing allogeneic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. The patient had a history of multiple COVID-19 infections. Imaging revealed extensive pneumoperitoneum and mesenteric emphysema; nevertheless, the patient remained clinically stable with a benign abdominal examination. She eventually recovered after 1 month of conservative treatment. We believe the PCI in this case had a multifactorial etiology, potentially involving both HSCT and COVID-19. Raising awareness of PCI may help avoid unnecessary surgical interventions and associated morbidity.
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Affiliation(s)
- Sha-Sha You
- Department of Hematology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zhou-Ning Lin
- Department of Hematology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Li-Xia Sheng
- Department of Hematology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yan-Li Lai
- Department of Hematology, The First Affiliated Hospital of Ningbo University, Ningbo, China
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González-Palacio CL, Venegas-Yáñez CE, Enríquez-Sánchez LB, Carrillo-Gorena MJ, Aguirre-Baca A. Finding of gastric pneumatosis on a computed tomography scan as a sign of gastric ischemia secondary to probable thrombosis in a patient with chronic kidney disease: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:443-445. [PMID: 34391701 DOI: 10.1016/j.rgmxen.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/10/2020] [Indexed: 10/20/2022]
Affiliation(s)
| | - C E Venegas-Yáñez
- Departamento de Cirugía General, Hospital Central del Estado, Chihuahua, Mexico
| | | | | | - A Aguirre-Baca
- Universidad Autónoma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Chihuahua, Mexico
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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: 1.0] [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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González-Palacio CL, Venegas-Yáñez CE, Enríquez-Sánchez LB, Carrillo-Gorena MJ, Aguirre-Baca DA. Finding of gastric pneumatosis on a computed tomography scan as a sign of gastric ischemia secondary to probable thrombosis in a patient with chronic kidney disease: A case report. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:S0375-0906(21)00001-X. [PMID: 33558120 DOI: 10.1016/j.rgmx.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/12/2020] [Accepted: 10/10/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - C E Venegas-Yáñez
- Departamento de Cirugía General, Hospital Central del Estado, Chihuahua, México
| | | | | | - D A Aguirre-Baca
- Universidad Autónoma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Chihuahua, México
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Miwa W, Hiratsuka T, Sato K, Kato Y. Pneumatosis cystoides intestinalis accompanied by intestinal spirochetosis. Clin J Gastroenterol 2020; 13:545-551. [PMID: 31898208 DOI: 10.1007/s12328-019-01087-2] [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: 10/06/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
Pneumatosis cystoides intestinalis (PCI) is a rare but well-recognized entity characterized by multiple gas-filled cysts in the intestinal wall. Although the pathogenesis of PCI remains unclear, several theories, including a bacterial theory, have been postulated. Intestinal spirochetosis (IS) is an uncommon condition defined by the presence of spirochetes attached to the surface of the colonic epithelium. The nature of IS as a commensal or pathogenic process remains debatable. However, recent evidence supports the idea that IS can be invasive and highly pathogenic in both immunocompromised and immunocompetent individuals. We present the case of a 35-year-old asymptomatic and immunocompetent man who underwent colonoscopy because of a positive fecal blood test. Multiple submucosal cystic lesions were detected accompanied by erythematous areas along the ascending colon. Computed tomography-colonography and biopsy specimens from the erythematous areas confirmed coexisting PCI and IS. Both PCI and IS recovered completely 3 months after administration of metronidazole. To the best of our knowledge, this case represents only the second report of the extremely rare concurrence of PCI with IS. Taking into account the published literature, we also discuss the possibility that the development of PCI may be related to IS.
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Affiliation(s)
- Wataru Miwa
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro, Toshima-ku, Tokyo, 171-0021, Japan.
| | - Takashi Hiratsuka
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro, Toshima-ku, Tokyo, 171-0021, Japan
| | - Ken Sato
- Division of Surgery, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
| | - Yo Kato
- Department of Pathology, Nikko Medical Center, Dokkyo Medical University, Tochigi, Japan
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Walczak R, Paek M, Suran J, Amory JT, Specchi S, Sanchez M. Radiography and ultrasonography of pneumatosis intestinalis in a cat. Vet Radiol Ultrasound 2018; 61:E26-E30. [DOI: 10.1111/vru.12635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/14/2018] [Accepted: 02/21/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Raelyn Walczak
- Department of RadiologyGulf Coast Veterinary Specialists Houston TX 77027
| | - Matthew Paek
- Department of RadiologySynergy Veterinary Imaging Partners Rockville MD 21029
| | - Jantra Suran
- Section of RadiologyUniversity of Pennsylvania Philadelphia PA 19104
| | - Joseph T. Amory
- Department of RadiologyIDEXX Telemedicine Consultants Clackamas OR 97015
| | - Swan Specchi
- Department of Clinical SciencesIstituto Veterinario di Novara Strada Provinciale 9 Granozzo con Monticello Italy
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