Pneumatosis cystoides intestinalis associated with gastric outlet obstruction; A case report

INTRODUCTION AND IMPORTANCE

Pneumatosis cystoides intestinalis (PCI) is defined as the presence of air-filled cysts in the bowel wall. The overall incidence of pneumatosis cystoides intestinalis in the general population is very rare.

PRESENTATION OF CASE

This is a 44-year-old male patient who presented with epigastric abdominal pain and repeated vomiting of one-month duration. The patient was emaciated; vital signs were within normal limits. The abdomen was grossly distended. Laboratory tests, radiologic imaging, and upper gastrointestinal endoscopy were performed. The diagnosis of gastric outlet obstruction (GOO) secondary to peptic ulcer disease cicatrization along with the coincidental finding of PCI with hepato-diaphragmatic interposition of the small bowel (Chilaiditi sign) was made. Truncal vagotomy, gastrojejunostomy, and Braun jejunojejunostomy was performed. Adhesionolysis and repositioning of the ileum back into its' normal infracolic location was also done.

CLINICAL DISCUSSION

The causes of PCIs are multifactorial; however, the exact etiology is not well known. PCIs have a wide range of non-specific presenting symptoms such as bloody stools, diarrhea or constipation, vomiting, abdominal pain, flatulence, and weight loss. The diagnosis of PCI is made based on endoscopy and radiographic evaluation of the alimentary tract. The appropriate therapy depends on the underlying etiology and the presence of complications.

CONCLUSION

In the absence of complication, PCI can be managed conservatively. However, in the presence of an indication for surgery, PCI related with bowel interposition in the hepato-diaphragmatic space; concomitant repositioning and adhesion release may help to alleviate the symptoms and prevent further complication of PCI.

[Intestinal pneumatosis developed during the treatment of severe gastrointestinal graft-versus-host disease after cord blood transplantation]

A 62-year-old female developed stage4 gastrointestinal graft-versus-host disease (GVHD) on day 109 following an allogeneic cord blood transplant for relapsed refractory angioimmunoblastic T-cell lymphoma. GVHD went into remission 4 weeks after receiving the steroid (mPSL 1 mg/kg), but abdominal bloating started to emerge at the same time. A diagnosis of intestinal pneumatosis was made on day 158 after a CT scan revealed submucosal and serosal pneumatosis in the entire colon, and intestinal pneumatosis was identified as the cause. Fasting and reducing steroid use have helped. the abdominal symptoms, and the pneumatosis disappeared on day 175. No more flare-ups occurred, and the steroid was successfully stopped. After allogeneic transplantation, intestinal pneumatosis is a rather uncommon complications. Its pathogenesis is thought to be influenced by GVHD or steroids. Treatments for the disease may be incompatible with one another, and the response in individual cases needs to be studied in detail.