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Pneumatosis cystoides intestinalis. Conservative approach in non surgical pneumoperitoneum: a case report and literature review.

An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His general condition allowed a thorough clinical and laboratory investigation which resulted in the diagnosis of the disease and the avoidance of an unnecessary laparotomy. PCI is a relatively rare condition characterized by multiple intramural pockets of gas involving any portion of the gastro intestinal tract. Various theories reflect either a mechanical or a bacterial etiology. Most of the patients are asymptomatic although some experience gastrointestinal complaints. The majority of patients require no treatment.

Aged↗

Pneumatosis cystoides intestinalis and high breath H2 excretion: insights into the role of H2 in this condition.

Patients with pneumatosis cystoides intestinalis have been reported to excrete excessive H2 because of a lack of H2-consuming intestinal bacteria. This study describes a patient with bacterial overgrowth and pneumatosis of the small intestine whose colonic flora avidly consumed H2 but whose small bowel flora produced but did not consume H2. There is no commonly accepted mechanism whereby excessive luminal H2 causes intramural gas. An explanation is proposed in which an initial, transitory source of intramural gas is distinguished from the mechanism that results in the persistence of the gas. Independent of the initial source of gas, rapid diffusion of H2 from the lumen into an intramural gas bubble would cause N2, O2, and CO2 to diffuse from the blood into the bubble. As a result, the bubble would expand and then persist indefinitely as long as H2 continued to diffuse from the lumen to the intramural gas collection.

Aged↗

A severe case of pneumatosis cystoides intestinalis with massive accumulation of gas outside the gastrointestinum.

We report an unusually severe case of pneumatosis cystoides intestinalis in an adult female patient undergoing chemotherapy for lymphoblastic crisis in chronic myelogenous leukemia. An impressive accumulation of gas was not only detected within the intestinal wall and mesentery but also in the peritoneum, retroperitoneum, mediastinum and cervical subcutaneous tissue. The patient was almost asymptomatic and fully recovered within a few days of treatment. In addition to chemotherapy, the patient was receiving trimethoprim/sulfamethoxazole for pneumocystis carinii pneumonia and lactulose for constipation. Mucosal damage due to chemotherapy and depletion of tetrahydrofolic acid, changes in bowel flora induced by antibiotic treatment, and the intake of unabsorbable carbohydrates may be responsible for the severity of the disease.

Aged↗

Pneumatosis cystoides intestinalis: Report of 3 cases with special reference to its non-surgical treatment.

Three patients with pneumatosis cystoides intestinalis had been reported. All patients are females with lesions in the left and sigmoid colon, grouped as idiopathic etiology. Two patients are in middle age, workers in the manufacturing plant for electric apparatus. One patient received surgical resection of the affected segment. After oral antibiotics treatment, one patient was resected only the intensely affected segment, so that many cysts were still remained, but they disappeared after 3 weeks. One patient was treated with lactobacillus preparations and lactulose. Her subjective symptoms and fecal occult blood disappeared, and X-ray studies and endoscopic examination revealed an almost complete recovery.

Adult↗

Pneumatosis cystoides intestinalis and trichloroethylene exposure.

A case-control study was carried out to assess the association between pneumatosis cystoides intestinalis (PCI) and working conditions, including occupational exposure to organic solvents. Thirteen patients with primary PCI were individually matched with controls by sex, age, and admission year. It was found that there was a close association between the development of primary PCI and occupational exposure to trichloroethylene (TCE). Twelve of 13 patients with PCI (92.3%) were found to have been exposed occupationally to TCE, and the healing and recurrence of PCI in these patients substantially paralleled the profile of their occupational exposure to TCE. Two pairs of patients with PCI had been working in the same factories, where they had degreased camera lenses with TCE. These results suggest that chronic exposure to TCE could be one of the etiological factors in PCI.

Adult↗

Spontaneous benign pneumoperitoneum complicating scleroderma in the absence of pneumatosis cystoides intestinalis.

We describe a 64 year old woman with a 3-year history of scleroderma who presented as an emergency with increasing painless abdominal distention. Radiological investigations revealed a pneumoperitoneum in the absence of either visceral perforation or pneumatosis cystoides intestinalis. This is only the fourth report of spontaneous benign pneumoperitoneum complicating scleroderma without pneumatosis cystoides intestinalis. The possible aetiology of this condition is discussed.

Female↗

[Pneumatosis cystoides intestinalis: associated diseases, morphology and presumed pathogenesis].

Based on six cases, the clinical presentation, morphology and presumable pathogenesis of pneumatosis cystoides intestinalis (PCI) are discussed. As a rule PCI is not a disease in its own right, but a complication of very different, in part extraintestinal diseases. These can be subsumed in three groups. Group 1 includes patients with PCI as a complication of lung disease and initially normal intestinal status. The patients in group 2 develop pneumatosis on the grounds of intestinal disease secondary to primary extraintestinal or generalized disease. In group 3 pneumatosis develops as a complication of primary gastrointestinal disease.

Aged↗

A new approach to Pneumatosis cystoides intestinalis by target air-enema CT.

A 48-yr-old man was admitted to our hospital with abdominal discomfort and distension. A barium enema showed multiple radiolucent filling defects in the wall of the ascending colon. Colonic endoscopy revealed numerous round, polypoid masses covered with normal mucosa. These findings suggested Pneumatosis cystoides intestinalis. Target air-enema computed tomography was performed to make a final diagnosis, and demonstrated several gas collections covered with soft tissue in the wall of the ascending colon. This is the first reported case of Pneumatosis cystoides intestinalis in which multiple gas-filled cysts could be recognized by target air-enema computed tomography.

Abdominal Pain↗

Pneumatosis cystoides intestinalis arising in jejunal diverticular disease: report of a case and a suggestion to its pathogenesis.

The occurrence of pneumatosis cystoides intestinalis (PCI) in the gastrointestinal tract is rare. Among the cases already documented in the English language literature, the association of PCI with jejunal diverticulosis has only been mentioned once or twice. We herein report a case of a 63-year-old woman who had both entities concurrently in a segment of the jejunum. What is important to note is the relationship of PCI to the diverticulosis and its possible pathogenesis. Through histological examination and review of related articles, we are convinced that a mechanical theory plays a pivotal role when both diseases occur in the same segment of intestine and are compounded by obstruction or impaired peristalsis. This finding, when properly applied to PCI in other settings, helps to resolve the pathogenesis of PCI and other related gas-filled cysts.

Diverticulum↗

Pneumatosis cystoides intestinalis: a rare cause of nonsurgical pneumoperitoneum in an infant.

The authors describe a 3-year-old boy with pneumatosis cystoides intestinalis (PCI) and associated duodenal stenosis who came to them with abdominal pain, significant abdominal distension, large gastric residue, and pneumoperitoneum. PCI is a rare condition in children characterized by the presence of multiple gas-filled cysts within the wall of some part of gastrointestinal tract that may break and cause pneumoperitoneum without an intestinal perforation. Even if in most cases the standard treatment is surgical, to keep in mind this rare condition could be useful to adopt a most rational treatment approach and avoid unnecessary operation in case of "benign" pneumoperitoneum.

Child, Preschool↗

[Pneumatosis cystoides intestinalis in dolicho-sigmoid colon with functional signs].

We present a patient with dolicho sigmoid colon who as admitted with severe functional signs and symptoms. Sigmoid colectomy was performed because of additional radiologic and endoscopic findings revealing an atypical, circumscribed massive polyposis. On histological examination typical pneumatosis cystoides intestinalis was found. This case of pneumatosis cystoides reveals the difficulties in diagnosing this disease, mechanically induced mucosul lesions caused by impaired motility are discussed as a possible etiology in this case.

Colon, Sigmoid↗

Pneumatosis cystoides intestinalis in relapsing polychondritis.

Relapsing polychondritis (RP) is a rare systemic disease characterized by an inflammatory process involving predominantly cartilaginous structures. Pneumatosis cystoides intestinalis (PCI) in RP has not been reported previously. We report a case of PCI in RP that was successfully treated with high oxygen and antibiotics.

Adult↗

[Pneumatosis cystoides intestinalis, as a rare complications of coeliac disease].

Intestinal pneumatosis cystoides is rarely diagnosed clinical entity characterized by multiple gas containing cysts inside the wall of the gastrointestinal tract. Primary (15%) and secondary (85%) forms are known. In the more frequent secondary forms small intestine and the right side of the colon are mainly affected, and the underlying pathology can be gastrointestinal, pulmonary or immunological. The 64 year old male patient reported by the authors showed clinical signs of severe malabsorption (his body weight: 47,5 kg, height: 178 cm, BMI: 15). The intestinal pneumatosis was diagnosed by exploration performed because of suspected perforation (pneumoperitoneum). Due to severe malabsorption the patient was admitted to Gastroenterological Department. Duodenoscopy and small bowel biopsy was performed. Small intestinal histology and presence of anti-gliadin and anti-endomysium antibody confirmed the suspected diagnosis of coeliakia. Parenteral nutrition, special gliadin free diet, hyperbaric oxygen inhalation, steroid, and metronidazole treatment resulted in a gradual improvement in the nutritional and general condition of the patient. After one year the patient is without complaints, he gained 24,5 kg body weight BMI: 22,5). The author's case points to a rare serious complication of non-treated coeliakia. Recognition of intestinal pneumatosis in time could have prevented surgical intervention in the high risk patient.

Biopsy↗