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PubMed2003

Primary pneumotosis cystoides intestinalis.

We describe an unusual case of pneumatosis cystoides intestinalis (PCI) in a patient with chronic pulmonary disease. A 79-year-old woman was hospitalized due to abdominal fullness and bowel habit change. Colonoscopy revealed numerous round cystic lesions in the sigmoid colon, which bled easily on contact. Due to persistent local peritonitis, a left hemicolectomy with primary anastomosis was performed. The patient has done well in the 12 months following surgery.

Aged↗
PubMed1996

[Pneumoperitoneum and pneumoretroperitoneum without perforation].

Asymptomatic radiologically recognised pneumoperitoneum still remains a diagnostic and therapeutic dilemma, because free intraperitoneal air is not necessarily caused by alimentary tract perforation. We present two cases of nonsurgical pneumoperitoneum (caused by pneumomediastinum and pneumatosis intestinalis cystoides) and their typical radiologic findings. Other causes of pneumoperitoneum that do not necessitate laparotomy so as cited in the radiologic and surgical literature are discussed.

Adult↗
PubMed1988

Pneumatosis masquerading as abdominal free air.

Pneumatosis cystoides intestinalis is an uncommon disease characterized by submucosal or subserosal collections of gas in the gastrointestinal tract and its peritoneal attachments. The literature suggests that the clinical course of this illness may be benign and self-limited. Clinical manifestations range from nonspecific gastrointestinal complaints to life-threatening complications of intestinal obstruction or pneumoperitoneum. Radiographic evidence of pneumoperitoneum in relatively asymptomatic patients suggests pneumatosis cystoides intestinalis. Correct radiographic diagnosis may avoid unnecessary surgery. In this unusual case, a patient with apparent subdiaphragmatic free air on radiograph was diagnosed as having pneumatosis cystoides intestinalis that involved the submucosa of the stomach and was related only to severe gastric dilatation. The case was managed expectantly, resulting in resolution of all radiographic findings and complete symptomatic recovery.

Aged↗
PubMedDate not supplied

[Pneumatosis intestinalis. Report of 3 cases].

OBJECTIVE: To describe the clinical, radiological, morphological, and immunohistochemical characteristics of three cases of pneumatosis intestinalis. METHODS: From 1982 to 1999, cases diagnosed as pneumatosis cystoides intestinalis were reviewed. The laboratory results, X-ray findings, clinical course, treatment and evolution were obtained from the clinical charts. Slides and macroscopic photos were obtained from the surgical pathology files. New slides were obtained from the paraffin blocks for immunohistochemical detection of endothelial cells (CD 31) and macrophagic cells (CD 68). RESULTS: We found three patients with pneumatosis intestinalis associated to a history of abdominal surgeries from 936 enteral resections (0.3%). These three patients showed clinical features of intestinal obstruction. Morphological and immunohistochemical analysis showed pseudocysts without an epithelial and endothelial lining. Some spaces were lined by multinucleated giant cells positive for CD 68 and endothelial cells that were CD 31 positive. CONCLUSIONS: Antecedent of obstruction and abdominal surgeries were the constant association with pneumatosis cystoides intestinalis. Most lesions were pseudocysts without epithelial or endothelial lining.

Abdominal Pain↗
PubMed1991

Pneumatosis and pneumoperitoneum in chronic idiopathic intestinal pseudoobstruction.

Chronic idiopathic intestinal pseudoobstruction is a diagnosis of exclusion for the rare patient with severe small bowel atony without any demonstrable organic cause. The very poor prognosis associated with this disease has been somewhat improved with the advent of parenteral nutrition; nevertheless, these patients follow a stormy course characterized by malnutrition, recurrent obstruction, infection, hemorrhage, and perforation. We describe a 16-year-old boy with this disease who presented to us with vague abdominal pain and pneumoperitoneum. Laparotomy showed pneumatosis cystoides intestinalis without intestinal perforation. The presence of free air in the abdominal cavity is an almost pathognomonic sign of intestinal perforation. Pneumatosis cystoides intestinalis is one of the very few nonsurgical causes of pneumoperitoneum. Beyond the neonatal period, in which it is the hallmark of necrotizing enterocolitis, it has been described in patients with severe obstructive lung disease, in collagenous disorders, and in the short-bowel syndrome. In the present case, it may have resulted from chronic intestinal distension, allowing air under pressure to dissect through the bowel wall. The challenge of such a unique association of conditions lies in the avoidance of unnecessary surgery in a chronic, essentially nonsurgical disease while avoiding unnecessary delay in a possibly acute surgical event.

Child↗
PubMed1988

Pneumo-retroperitoneum associated with pneumatosis cystoides intestinals.

Pneumatosis cystoides intestinalis, a rare disease characterised by gas cysts involving portions of the intestinal tract, is obscure in its etiology and intriguing in its presentation. Amongst several theories a new concept suggest that retroperitoneal gas is a probable source of origin. Experimental studies in animals have demonstrated that air can track down the mediastinum into the retroperitoneum and thereby into the gut wall from an alveolar rupture. A case of pneumo-retroperitoneum in a patient with pneumatosis cystoides intestinalis is now reported.

Aged↗
PubMedDate not supplied

Pneumatosis cystoides of the right colon: a possible source of misdiagnosis. Report of a case.

Pneumatosis cystoides intestinalis is a rare condition that can be located in any part of the gastrointestinal tract. It is usually associated with a wide variety of gastrointestinal or pulmonary diseases. The primitive form is much less frequent and usually involves the left colon. The pathogenesis of pneumatosis cystoides intestinalis is still unclear. The mechanical theory, which is the most accepted explanation, postulates that gas is forced into the bowel wall by breaks in the mucosa; this is more likely to occur when the intraluminal pressure is higher, as happens in obstructive conditions, during endoscopies, or during infections from gas-forming bacteria. Pneumatosis cystoides is often asymptomatic, representing an occasional finding during investigations for other abdominal conditions. Complications occur in about 3% of cases and include obstruction, intussusception, volvulus, haemorrhage and intestinal perforation. When presenting acutely or in association with other abdominal conditions the differential diagnosis is rarely a problem. More important is to diagnose asymptomatic primitive submucosal pneumatosis of the colon, in order to avoid unnecessary intestinal resections. The Authors present the case of a patient with pneumatosis coli who underwent laparotomy for a suspected colonic lipomatosis of the right colon.

Colon↗
PubMedDate not supplied

Immunotoxicity of trichloroethylene: a study with MRL-lpr/lpr mice.

In recent immunological studies, it has been suggested that trichloroethylene (TCE) participates in the onset of pneumatosis cystoides intestinalis (PCI) through a certain mechanism; however, the mechanism by which it develops remains unknown. Based on findings that secondary PCI is often linked with autoimmune disease, the possibility that some genetic or immunological mechanisms are involved in the development of PCI has been proposed. Pneumatosis cystoides intestinalis is not a type of disease where a dose-response relationship with TCE exposure can be recognized and it is difficult to reproduce its physiopathology through TCE exposure in ordinary experimental animals. In the present study, immunological changes caused by TCE exposure were investigated by employing MRL-lpr/lpr mice that are genetically labile to autoimmune diseases. To observe changes in B cell functions, serum antibody titres were measured; and for the T cell function, T cell subsets were examined. The animals were exposed to TCE at dosages of 0, 500, 1000 and 2000 ppm through inhalation 4 h a day, 6 days a week, for 8 weeks. It was found that only IgG production capacity was suppressed and there were no changes in T cell subsets with TCE concentrations up to 1000 ppm. At a concentration of 2000 ppm, changes were noted in both T and B cell functions. Typical organs that are responsible for immunological functions were examined for their morphological changes under a light microscope: the spleen and liver exhibited dose-response changes at a concentration of 500 ppm or greater. The development of immunoblastoid cells at a concentration of 1000 ppm indicated a possibility that a change has occurred in the immunological system. These findings show that exposure to TCE at high concentrations affects the immune system, but the study failed to induce PCI in the experimental animals. Further studies on TCE exposure at lower concentrations for longer periods are needed.

Anesthetics, Inhalation↗
PubMed2006

Pneumatosis coli induced by acarbose administration for diabetes mellitus. Case report and literature review.

The authors report a case report of rare disease interesting the digestive tract and often associated to the other gastrointestinal pathologies and/or pulmonary diseases and can be also associated to not gastrointestinal conditions such as collagen-vascular disease, transplantation, AIDS, use of corticosteroid and chemotherapy; other causes can be iatrogenic such as traumatic gastrointestinal endoscopy (a mucoses biopsy, a polipectomy) or the assumption of lattulosio; in 15-20% of cases the pneumatosis cystoides intestinalis is considered primitive. In the our case the Pneumatosis coli was associated to administration of acarbose; in international literature only four papers in the English language were reported. Our patient showed a strongly aspecific symptomatology and easily attributable in first line or to the pathology of base (diabetic patient) or to the assumption of the acarbose; from about 7-8 months she showed unexplained episodes of crampy abdominal pain, diarrhea with 3-4 defecations/die with semiliquid and normochromic stools, tenesmus and a not better specified loss of weight. The diagnosis was been performed by colonoscopy and confirmed by abdominal CT scan with water enema and histologically; we have used the traditional radiology only to exclude the involvement of other gastroenteric districts. The patient was been treated with O2-therapy associated to antibiotics treatment; the suspension of the causal factor, the acarbose, has been of not secondary importance; the complete resolution of disease was obtained after 15 days of therapy.

Acarbose↗
PubMed1976

Pneumatosis coli associated with sigmoid volvulus and colonoscopy.

A case of interstitial emphysema involving the mesentery and serosa of the sigmoid colon after volvulus reduced by colonoscopy is presented. The case is reported as a form of pneumatosis intestinalis although it does not conform to the classical clinicopathologic picture of pneumatosis cystoides intestinalis. The infrequent occurrence of this condition in association with volvulus and/or colonoscopy is discussed.

Aged↗
PubMed1976

Necroqizing enterocolitis with pneumatosis intestinalis in systemic lupus erythematosus and polyarteritis.

Pneumatosis intestinalis was encountered in association with fatal necrotizing enterocolitis in systemic lupus erythematosus (SLE) and polyarteritis nodosa. The radiologic identification of mottled, bubbly, and linear collections of intramural intestinal gas distinguish this ominous complication from benign pneumatosis cystoides intestinalis. In the setting of intestinal vasculitis due to SLE or polyarteritis nodosa, these characteristic radiologic features indicate necrotizing enterocolitis. Since corticosteroids may mask clinical progression of the intestinal lesion, radiologic evaluation is essential in the overall management of the patient with intestinal vasculitis.

Adult↗
PubMed1989

Benign pneumoperitoneum in a patient with celiac sprue.

A patient with celiac sprue was found to have an asymptomatic pneumoperitoneum. Prompt recognition that the pneumoperitoneum was due to pneumatosis cystoides intestinalis prevented unnecessary surgical intervention. Severe mucosal disease of the small intestine can be associated with an asymptomatic pneumoperitoneum.

Aged↗
PubMed1995

[Hydrogen metabolism in the large intestine--physiology and clinical implications].

During the anaerobic metabolism of the colonic bacterial flora short chain fatty acids and the gases hydrogen (H2) and carbon dioxyde (CO2) are produced. In about 50% of a European and North-American population and in 90% of rural black Africans, methane is generated from H2 and CO2. In methane-negative individuals, sulfate reducing bacteria utilize H2 to reduce sulfate to sulfide. Methanogenesis and sulfate reduction are usually mutually exclusive. A competition exists for the common substrate hydrogen which is potentially regulated by the availability of sulfate in the colonic lumen. Other bacteria can use H2 to reduce CO2 to acetate (homoacetogenesis). Methane is an inert gas and has probably no direct effect in man. The metabolites of sulfate reduction (mercaptides, hydrogen sulfide) are toxic and hydrogen sulfide is supposed to play a role in the pathogenesis of ulcerative colitis. All H2-utilizing metabolisms reduce the gaseous volume in the colon and thus prevent flatulence. In patients with pneumatosis cystoides intestinalis methanogenesis is absent and sulfate reduction is insignificant. This deficiency provides an explanation for the massive H2-excretion in those patients and their symptoms.

Colitis, Ulcerative↗
PubMed1997

[Pneumatosis cystoides of the colon. Apropos of 7 cases].

Seven cases of pneumatosis cystoides intestinalis affecting the colon (PKC) revealed 5 times by a nonspecific symtomatology and 2 times by an occlusion were reported. In three of the patients the disease was found as a primary idiopathic form free of clinical antecedents. In 4 of the patients the pneumatosis was found to be secondary to a pulmonary disease, a gastric ulcer, a connectivite of a corticotherapy. The PKC was generally diagnosed either by barium enema or by computed tomography and less frequently by colonoscopy with deep biopsy allowing differential diagnosis with colonic polyposis. The mechanism and etiology of the PKC were not fully understood. The illness is a benign condition that often responds to a conservative management--i.e. abstention, oxygenotherapy, diet or antibiotherapy- or exceptionally to surgical colonic resection in case of acute complication.

Aged↗