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A case of malrotation of the mid intestine with volvulus is reported in an infant in whom the clinical and radiological appearances were unusual, and had led to a misdiagnosis of necrotising enterocolitis. If the correct diagnosis had been made earlier, operation might have saved the infant's life.
A 68-year old female underwent removal of a 3 cm transverse colon polyp, which contained adenocarcinoma, by means of endoscopic polypectomy. She tolerated the procedure well. Unfortunately, six hours later she returned to the hospital with vague abdominal complaints. Her clinical exam revealed mild abdominal tenderness, but was not suggestive of a perforated viscus. Radiographic data revealed retroperitoneal, mediastinal, and free intraperitoneal air, along with intramural bowel wall air.
A 67-year-old woman was admitted to our hospital with a complaint of abdominal pain. Barium enema examination and colonoscopy showed numerous round polypoid lesions covered with normal mucosa in the area from the ascending colon to the splenic flexure. Endoscopic ultrasound examination with an ultrasonic catheter probe revealed a strong echo with distal acoustic shadowing in the third layer of the diseased colonic wall, which suggested the presence of gas in the submucosa. The gaseous cysts disappeared completely after hyberbaric oxygen therapy at 2 to 3 atmospheres absolute (60 minutes, twice a day) for 30 consecutive days.
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A gnotobiotic pig monocontaminated with an enteropathogenic Escherichia coli was subsequently hyperimmunized to produce a monotypic antiserum. At necropsy, multiple, air filled cysts were found in the wall of the large intestine. The etiology of this condition is still conjectural. However, select strains of E. coli may cause or contribute to intestinal emphysema in swine.
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A patient with pneumatosis cystoides intestinalis noted on barium enema performed for evaluation of rectal bleeding was found on fiberoptic colonoscopy to have evidence of inflammatory bowel disease, consistent with granulomatous colitis, the sigmoid colon element of which responded to topical steroid therapy as documented by repeat colonoscopy three months later.
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Mucosal pseudolipomatosis is a recently described colonoscopic finding, most likely caused by intramucosal air. We describe four asymptomatic patients with this lesion which completely resolved 3 weeks later on repeat colonoscopy. This is a benign, transient lesion with distinct endoscopic and histologic findings. The similarity between mucosal pseudolipomatosis and pneumatosis cystoides intestinalis is supportive of the mechanical theory for pneumatosis cystoides intestinalis.
Pneumatosis cystoides intestinalis is a rare condition characterized by multiple subserosal or submucosal gas filled cysts within the wall of a segment of bowel. It is associated with numerous conditions, both intra and extraabdominal in nature. The condition may be asymptomatic or may present clinically as nausea, vomiting, diarrhea or other signs of intestinal obstruction. With rupture of the cysts, pneumoperitoneum may be a finding. In a patient with vague clinical presentation, this finding radiographically may lead to a clinical dilemma as many of these patients have comorbid conditions which are also associated with intestinal perforation. The authors present the case of a 47-year-old obese black female found to have massive pneumatosis intestinalis of the tranverse colon with a small amount of free intraperitoneal air. This case highlights the importance of recognizing pneumatosis intestinalis as a possible mimic of free intraabdominal air as well as a possible cause of benign pneumoperitoneum.