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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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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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Tropeano G, Di Grezia M, Puccioni C, Bianchi V, Pepe G, Fico V, Altieri G, Brisinda G. The spectrum of pneumatosis intestinalis in the adult. A surgical dilemma. World J Gastrointest Surg 2023; 15:553-565. [PMID: 37206077 PMCID: PMC10190725 DOI: 10.4240/wjgs.v15.i4.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/10/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
Pneumatosis intestinalis (PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic significance nowadays has to be cross-referenced to the nature of the underlying condition. Multiple mechanisms of pathogenesis have been debated and multiple causes have been detected during the years. All this contributes to creating a broad range of clinical and radiological presentations. The management of patients presenting PI is related to the determining cause if it is identified. Otherwise, in particular if an association with portal venous gas and/or pneumoperitoneum is present, the eventual decision between surgery and non-operative management is challenging, even for stable patients, since this clinical condition is traditionally associated to intestinal ischemia and consequently to pending clinical collapse if not treated. Considering the wide variety of origin and outcomes, PI still remains for surgeons a demanding clinical entity. The manuscript is an updated narrative review and gives some suggestions that may help make the decisional process easier, identifying patients who can benefit from surgical intervention and those who can benefit from non-operative management avoiding unnecessary procedures.
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Affiliation(s)
- Giuseppe Tropeano
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Marta Di Grezia
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Caterina Puccioni
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gilda Pepe
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Gaia Altieri
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Surgery, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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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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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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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: 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: 01/25/2022] [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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Toda Y, Komatsu S, Fukami Y, Saito T, Matsumura T, Osawa T, Kurahashi S, Uchino T, Kato S, Yasui K, Hanazawa T, Kaneko K, Sano T. Prognostic factors for the successful conservative management of nonocclusive mesenteric ischemia. World J Emerg Surg 2022; 17:32. [PMID: 35659015 PMCID: PMC9166604 DOI: 10.1186/s13017-022-00436-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/22/2022] [Indexed: 01/06/2023] Open
Abstract
Background The criteria for deciding upon non-operative management for nonocclusive mesenteric ischemia (NOMI) are poorly defined. The aim of this study is to determine the prognostic factors for survival in conservative treatment of NOMI. Methods Patients with bowel ischemia were identified by searching for “ICD-10 code K550” in the Diagnosis Procedure Combination database between June 2015 and May 2020. A total of 457 patients were extracted and their medical records, including the clinical factors, imaging findings and outcomes, were analyzed retrospectively. Diagnosis of NOMI was confirmed by the presence of specific findings in contrast-enhanced multidetector-row CT. Twenty-six patients with conservative therapy for NOMI, including four cases of explorative laparotomy or laparoscopy, were enrolled. Results Among the 26 cases without surgical intervention, eight patients (31%) survived to discharge. The level of albumin was significantly higher, and the levels of lactate dehydrogenase, total bilirubin, C-reactive protein, and lactate were significantly lower in the survivors than the non-survivors. Sepsis-related Organ Failure Assessment (SOFA) score was significantly lower in the survivors than the non-survivors. The most reliable predictor of survival for NOMI was SOFA score (cutoff value ≤ 3 points), which had the highest AUC value (0.899) with odds ratio of 0.075 (CI: 0.0096–0.58). Conclusions The SOFA score and several biological markers are promising predictors to determine a treatment plan for NOMI and to avoid unnecessary laparotomy. Supplementary Information The online version contains supplementary material available at 10.1186/s13017-022-00436-w.
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Affiliation(s)
- Yoko Toda
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Yasuyuki Fukami
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tatsuki Matsumura
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shintaro Kurahashi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kohei Yasui
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Hanazawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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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: 2.0] [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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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: 0.5] [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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Arroyave Guerrero YA, Ruiz Beltrán GH, Meza Cabrera MDM, Muñoz Ruiz EO, Muñoz Ordoñez GW. Neumatosis quística intestinal y peritoneal, causa de neumoperitoneo. Revisión de la literatura a propósito de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introducción. La neumatosis intestinal es una condición rara que se caracteriza por la infiltración submucosa o subserosa de gas en el tubo digestivo. Se encuentra más frecuentemente en el intestino delgado y, pocas veces, en localización extraintestinal. Su prevalencia estimada es de 0,03 %.
Métodos. Se hizo una búsqueda bibliográfica en las bases de datos biomédicas Medline Pubmed, Science Direct, Tripdatabase y Uptodate, usando como palabras clave ‘neumoperitoneo’ y ‘neumatosis cistoide intestinal’ Para la presentación del caso clínico, se tomaron datos de la historia clínica y, además, imágenes de radiografía, tomografías y material fotográfico del procedimiento quirúrgico.
Presentación del caso. Se trata de una mujer de 63 años de edad con antecedentes de colagenopatía, que consultó por dolor y distensión abdominal. Aunque no tenía signos de irritación peritoneal, las imágenes diagnósticas revelaron neumoperitoneo y líquido libre en la cavidad peritoneal, por lo que se sospechó una perforación intestinal y se practicó una laparotomía exploratoria, en la cual se encontró neumatosis quística intestinal y peritoneal.
Conclusiones. No todos los casos de neumoperitoneo requieren cirugía. Existen casos espontáneos y sin irritación peritoneal, secundarios a neumatosis quística intestinal. En los casos de neumoperitoneo en pacientes estables con un diagnostico etiológico no muy claro, y en quienes se desee descartar perforación intestinal o isquemia mediante exploración quirúrgica, la laparoscopia diagnóstica es una buena opción y menos agresiva que la laparotomía.
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Gastric Outlet Obstruction and Sigmoid Volvulus in a Patient with Pneumatosis intestinalis: An Etiology or a Complication. Case Rep Surg 2019; 2019:4065749. [PMID: 31380139 PMCID: PMC6652069 DOI: 10.1155/2019/4065749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/09/2019] [Accepted: 06/24/2019] [Indexed: 12/27/2022] Open
Abstract
Pneumatosis intestinalis (PI) is a radiographic finding which refers to the presence of gas within the wall of any part of the gastrointestinal tract. While in some cases it is an incidental finding which usually represent its benign nonischemic etiology, it may indicate a catastrophic intra-abdominal condition and distinctly characteristic of ischemic enterocolitis. Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management and outcome of an extremely rare concurrent triad of PI, gastric outlet obstruction, and the sigmoid volvulus based on a case of a patient who underwent surgery in our hospital, which, we think, can emphasize the mysterious concept of PI's mechanical etiology.
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Mehrkhu M, Shirvani Dehkordi I, Shirvani Dehkordi P, Shirvani Dehkordi A. Pneumatosis intestinalis in an adult patient with antral stenosis and midgut malrotation. BMJ Case Rep 2018; 2018:bcr-2017-223238. [PMID: 30030242 DOI: 10.1136/bcr-2017-223238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that underwent diagnostic surgery and finally diagnosed by midgut malrotation and antral stenosis. A 40-year-old man with 1-year history of dyspepsia and vomiting which was aggravated by 20 kg underweight since 3 months ago, despite medications was presented. His imaging examinations showed partial antral obstruction besides pneumoperitoneum and gas collection in the small intestine wall, which were in favour of PI. Samplings of the small intestine during laparotomy reported simple serosal cysts. Persistence of his symptoms forced him to recourse to another hospital and their new imaging revealed Ladds' band in addition to mentioned findings in previous studies; he underwent subtotal gastrectomy plus Ladds' band division by Braun gastrojejunostomy. PI could be a presentation of antral stenosis and midgut malrotation. PI with pneumoperitoneum needs surgical interventions. Considering that most of the midgut malrotation cases are diagnosed in the first year of life and it is very rare in adults, it may bethat these new findings are due to adhesion band formation after the first surgery in this case.
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Affiliation(s)
- Mehrnaz Mehrkhu
- Department of Medicine, Student Research Committee, Lorestan University of Medical Sciences, Faculty of Medicine, Khorramabad, Iran
| | - Iman Shirvani Dehkordi
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Pooya Shirvani Dehkordi
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Amir Shirvani Dehkordi
- Department of Emergency Medicine, Emergency Medicine Research Center (Al-Zahra Research Institute), Isfahan University of Medical Sciences, Isfahan, Iran
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Okuda Y, Mizuno S, Koide T, Suzaki M, Isaji S. Surgical treatment of pneumatosis cystoides intestinalis with pneumoperitoneum secondary. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:131-133. [PMID: 29391321 DOI: 10.5152/tjg.2018.17519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Taihei Koide
- Department of Surgery, Kinan Hospital, Mie, Japan
| | | | - Shuji Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
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Furihata T, Furihata M, Ishikawa K, Kosaka M, Satoh N, Kubota K. Does massive intraabdominal free gas require surgical intervention? World J Gastroenterol 2016; 22:7383-7388. [PMID: 27621584 PMCID: PMC4997647 DOI: 10.3748/wjg.v22.i32.7383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/24/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
We describe a rare case of an 81-year-old man who presented with severe epigastralgia. A chest radiograph showed massive free gas bilaterally in the diaphragmatic spaces. Computed tomography (CT) scan also showed massive free gas in the peritoneal cavity with portal venous gas. We used a wait-and-see approach and carefully considered surgery again when the time was appropriate. The patient received conservative therapy with fasting, an intravenous infusion of antibiotics, and nasogastric intubation. The patient soon recovered and was able to start eating meals 4 d after treatment; thus, surgical intervention was avoided. Thereafter, colonoscopy examination showed pneumatosis cystoides intestinalis in the ascending colon. On retrospective review, CT scan demonstrated sporadic air-filled cysts in the ascending colon. The present case taught us a lesson: the presence of massive intraabdominal free gas with portal venous gas does not necessarily require surgical intervention. Pneumatosis cystoides intestinalis should be considered as a potential causative factor of free gas with portal venous gas when making the differential diagnosis.
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Vinzens F, Zumstein V, Bieg C, Ackermann C. Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management. BMJ Case Rep 2016; 2016:bcr-2016-215816. [PMID: 27229749 DOI: 10.1136/bcr-2016-215816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients presenting with abdominal pain and pneumoperitoneum in radiological examination usually require emergency explorative laparoscopy or laparotomy. Pneumoperitoneum mostly associates with gastrointestinal perforation. There are very few cases where surgery can be avoided. We present 2 cases of pneumoperitoneum with unknown origin and successful conservative treatment. Both patients were elderly women presenting to our emergency unit, with moderate abdominal pain. There was neither medical intervention nor trauma in their medical history. Physical examination revealed mild abdominal tenderness, but no clinical sign of peritonitis. Cardiopulmonary examination remained unremarkable. Blood studies showed only slight abnormalities, in particular, inflammation parameters were not significantly increased. Finally, obtained CTs showed free abdominal gas of unknown origin in both cases. We performed conservative management with nil per os, nasogastric tube, total parenteral nutrition and prophylactic antibiotics. After 2 weeks, both were discharged home.
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Affiliation(s)
- Fabrizio Vinzens
- Department of Visceral Surgery, St Claraspital Basel, Basel, Schweiz, Switzerland
| | - Valentin Zumstein
- Department of Visceral Surgery, St Claraspital Basel, Basel, Schweiz, Switzerland
| | - Christian Bieg
- Department of Radiology, St Claraspital Basel, Basel, Schweiz, Switzerland
| | - Christoph Ackermann
- Department of Visceral Surgery, St Claraspital Basel, Basel, Schweiz, Switzerland
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Khalid F, Kaiyasah H, Binfadil W, Majid M, Hazim W, ElTayeb Y. Pneumatosis intestinalis due to gastrointestinal amyloidosis: A case report & review of literature. Int J Surg Case Rep 2016; 23:29-32. [PMID: 27085104 PMCID: PMC4855412 DOI: 10.1016/j.ijscr.2016.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/28/2016] [Indexed: 12/17/2022] Open
Abstract
Pneumatosis intestinalis is a poorly understood phenomenon with a multitude of causes. It may mimic other gastrointestinal conditions ranging from benign to life threatening ones. A high index of suspicion is required to reach the correct diagnosis in order to provide optimal care for the patient. G.I amyloidosis is among the rare causes for secondary pneumatosis intestinalis.
Introduction Pneumatosis intestinalis (PI) is not a disease but a radiological finding with a poorly understood pathogenesis. It can be divided into primary/idiopathic (15%) or secondary (85%) Kim et al. 2007, based on the factors thought to play a role in its development. Amongst the rare causes of secondary PI is gastrointestinal (GI) amyloidosis. Presentation of the case We report a case of a 46-year-old gentleman who presented with a one month history of acute on chronic abdominal pain, associated with one episode of melena. Upon further investigation, he was found to have pneumoperitoneum. He was taken to the operating theatre, where he was noted to have features of pneumatosis intestinalis of the small bowel with no evidence of bowel perforation. Postoperatively, he underwent an upper GI endoscopy with biopsies that revealed GI amyloidosis. Discussion One of the rare causes that can lead to secondary PI is GI amyloidosis as proven in our case. Patients with symptomatic gastrointestinal amyloidosis usually present with one of four syndromes: gastrointestinal bleeding, malabsorption, protein-losing gastroenteropathy, and, less often, gastrointestinal dysmotility. Conclusion GI amyloidosis is a rare cause of secondary pneumatosis intestinalis. The presentation of the disease varies from patient to patient, therefore, the management should be tailored accordingly.
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Affiliation(s)
- Filza Khalid
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE.
| | - Hadiel Kaiyasah
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Wafa Binfadil
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Maiyasa Majid
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Wessam Hazim
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
| | - Yousif ElTayeb
- General surgery department, Rashid hospital, Dubai Health Authority, Dubai, UAE
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Rathi C, Pipaliya N, Poddar P, Pandey V, Ingle M, Sawant P. A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis. Intest Res 2015; 13:346-9. [PMID: 26576141 PMCID: PMC4641862 DOI: 10.5217/ir.2015.13.4.346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 01/16/2023] Open
Abstract
Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.
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Affiliation(s)
- Chetan Rathi
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Nirav Pipaliya
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Prateik Poddar
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Vikas Pandey
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Prabha Sawant
- Department of Gastroenterology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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Ooi SMS. Pneumoperitoneum in a non-acute abdomen-pneumatosis cystoides intestinalis. Surg Case Rep 2015; 1:44. [PMID: 26943409 PMCID: PMC4747943 DOI: 10.1186/s40792-015-0046-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/22/2015] [Indexed: 11/10/2022] Open
Abstract
Aim The aim of this study is to increase the understanding of pneumatosis cystoides intestinalis (PCI) and its incidents. Method We report here a case of PCI in an 88-year-old man with a provisional diagnosis of perforated viscus and possible ischaemic bowels based on CT findings of pneumoperitoneum. The patient was found to have extensive PCI on his small bowels. We then systematically search the PubMed database for case reports for articles containing ‘pneumatosis intestinalis’ in their titles or key words. Results The study group consisted of 52 cases on PCI from the period of 2010–2014 with the focus on the adult population. The youngest patient was 18 years old and the oldest was 91 years old. The mean age was 60.4 years (range, 18–91 years old). There were 27 (52 %) females and 25 (48 %) males. The most common symptoms were abdominal pain (79 %) followed by nausea/vomiting (27 %) and abdominal distension (19 %). CT imaging was the most common investigation modality used (94 %). Three (6 %) of the patients had laparoscopic treatment while 20 (38 %) had laparotomy. Thirty-six (69 %) of them recovered uneventfully while 9 (17 %) of the patients died. Conclusion Although there have been more case reports published on PCI in the recent years, the understanding of this condition remains in the infancy stage. PCI can be difficult to diagnose and can be easily misdiagnosed as pneumoperitoneum in an acute abdomen. Often it is identified incidentally during operation. Asymptomatic PCI should be treated conservatively, while emergency laparotomy should be reserved for life threatening abdominal pathology.
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Ksiadzyna D, Peña AS. Segmental pneumatosis cystoides coli: Computed tomography-facilitated diagnosis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 108:510-3. [DOI: 10.17235/reed.2015.3790/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aziret M, Erdem H, Ülgen Y, Kahramanca Ş, Çetinkünar S, Bozkurt H, Bali İ, İrkörücü O. The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature. Int J Surg Case Rep 2014; 5:909-13. [PMID: 25460434 PMCID: PMC4275820 DOI: 10.1016/j.ijscr.2014.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression. PRESENTATION OF CASE Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest. DISCUSSION PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery. CONCLUSION In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.
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Affiliation(s)
- Mehmet Aziret
- Kars State Hospital Department of General Surgery, Turkey.
| | - Hasan Erdem
- Adana Training and Research Hospital Department of General Surgery, Adana, Turkey
| | - Yiğit Ülgen
- Kars State Hospital Department of Pathology, Kars, Turkey
| | | | - Süleyman Çetinkünar
- Adana Training and Research Hospital Department of General Surgery, Adana, Turkey
| | - Hilmi Bozkurt
- Adana Training and Research Hospital Department of General Surgery, Adana, Turkey
| | - İlhan Bali
- Namık Kemal University Department of General Surgery, Tekirdağ Turkey
| | - Oktay İrkörücü
- Adana Training and Research Hospital Department of General Surgery, Adana, Turkey
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Gurrado A, Giungato S, Catacchio I, Piscitelli D, Arborea G, Piccinni G, Testini M, Vacca A. Jejunal overexpression of peptide YY in celiac disease complicated with pneumatosis cystoides intestinalis. Clin Exp Med 2014; 15:527-32. [PMID: 25291987 DOI: 10.1007/s10238-014-0314-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/16/2014] [Indexed: 01/19/2023]
Abstract
A 61-year old man with coeliac disease and chronic lack of appetite, malabsorption and weight loss, despite the gluten-free diet, was operated because of a sub-diaphragmatic free air due to a small-bowel pneumatosis cystoides intestinalis (PCI). The jejunum showed granulomatous lesions with a honeycombed appearance of air cysts in the submucosa/subserosa. We found overexpression of peptide YY (PYY) into only the jejunum with PCI, while the expression was very weak or absent in the tissue without cysts. One year after surgery, he had no abdominal pain or PCI recurrence. The above chronic symptoms were plausibly attributable to the PYY.
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Affiliation(s)
- Angela Gurrado
- Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Policlinico, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Simone Giungato
- Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Policlinico, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Ivana Catacchio
- Internal Medicine Units, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124, Bari, Italy
| | - Domenico Piscitelli
- Unit of Pathology, Department of Emergency Surgery and Organ Transplantation, University Medical School, 70124, Bari, Italy
| | - Graziana Arborea
- Unit of Pathology, Department of Emergency Surgery and Organ Transplantation, University Medical School, 70124, Bari, Italy
| | - Giuseppe Piccinni
- Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Policlinico, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Mario Testini
- Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Policlinico, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Angelo Vacca
- Internal Medicine Units, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124, Bari, Italy
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Klimova K, Pérez Valderas M, Merino Rodríguez B, González Asanza C, Menchén Fernández-Pacheco P. Neumatosis quística intestinal como causa infrecuente de dolor abdominal crónico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:302-3. [DOI: 10.1016/j.rgmx.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/16/2014] [Accepted: 09/26/2014] [Indexed: 10/24/2022]
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23
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Klimova K, Pérez Valderas M, Merino Rodríguez B, González Asanza C, Menchén Fernández-Pacheco P. Pneumatosis cystoides intestinalis as an infrequent cause of chronic abdominal pain. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.11.003] [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: 10/24/2022] Open
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Antonini F, Gismondi G, Marraccini B, Macarri G. Multiple colonic submucosal tumors in a patient with chronic lung allograft dysfunction. Saudi J Gastroenterol 2014; 20:139-40. [PMID: 24705153 PMCID: PMC3987155 DOI: 10.4103/1319-3767.129480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Filippo Antonini
- Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy,Address for correspondence: Dr. Filippo Antonini, Department of Gastroenterology, A. Murri Hospital, A. Murri Road, PO Box 63900 - Fermo, Italy. E-mail:
| | - Giuseppe Gismondi
- Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy
| | - Barbara Marraccini
- Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy
| | - Giampiero Macarri
- Department of Gastroenterology, A. Murri Hospital, Polytechnic University of Marche, Fermo, Italy
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Wu LL, Yang YS, Dou Y, Liu QS. A systematic analysis of pneumatosis cystoids intestinalis. World J Gastroenterol 2013; 19:4973-4978. [PMID: 23946603 PMCID: PMC3740428 DOI: 10.3748/wjg.v19.i30.4973] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/02/2013] [Accepted: 07/01/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To increase the understanding, diagnosis and treatment of pneumatosis cystoides intestinalis (PCI) and to find the characteristics and potential cause of the disease in China.
METHODS: We report here one case of PCI in a 70-year-old male patient who received a variety of treatment methods. Then, we systematically searched the PCI eligible literature published from an available Chinese database from May 2002 to May 2012, including CBM, CBMDisc, CMCC, VIP, Wanfang, and CNKI. The key words were pneumatosis cystoides intestinalis, pneumatosis, pneumatosis intestinalis, pneumatosis coli and mucosal gas. The patients’ information, histories, therapies, courses, and outcomes were reviewed.
RESULTS: The study group consisted of 239 PCI cases (male:female = 2.4:1) from 77 reported incidents. The mean age was 45.3 ± 15.6 years, and the median illness course was 6 mo. One hundred and sixty patients (66.9%) were in high altitude areas. In addition, 43.5% (104/239) of the patients had potential PCI-related disease, and 16.3% had complications with intestinal obstruction and perforation. The most common symptom was abdominal pain (53.9%), followed by diarrhea (53.0%), distention (42.4%), nausea and vomiting (14.3%), bloody stool (12.9%), mucous stool (12.0%) and constipation (7.8%). Most multiple pneumocysts developed in the submucosa of the colon (69.9%). The efficacy of the treatments by combined modalities, surgery, endoscopic treatment, conservative approach, oxygen, and antibiotics were 100%, 100%, 100%, 93.3%, 68.3% and 26.3%, respectively.
CONCLUSION: PCI can be safely managed by conservative treatments, presents more frequently in males, in the large bowel and submucosa, than in females, in the small intestine and subserosa. High altitude residence maybe associated with the PCI etiology.
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Önder A, Kapan M, Önder H, Taşkesen F, Gül M, Aliosmanoğlu İ, Başol Ö, Taş İ. Pneumatosis Cystoides Intestinalis: Clinical Experience in a Single Center. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012. [DOI: 10.29333/ejgm/82551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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