SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case of pneumatosis cystoides of the intestine complicated by recurrent pneumoperitoneum is presented. The condition responded initially to treatment with oxygen but became resistant to this form of therapy during a period of five years.
Pneumatosis cystoides intestinalis (PCI) is the term for the formation of intramural gas filled cysts of unclear pathogenesis in the wall of the gastrointestinal tract. We report two patients with PCI where the diagnosis was confirmed by endoscopic puncture of a lesion, resulting in a complete deflation of the cyst, and two patients who underwent surgery. Endoscopy offers a safe and quick way to confirm the diagnosis of PCI. The immunohistochemical study revealed histiocytic cells and foreign body giant cells in the cystic wall, corresponding to a secondary histiocytic organization of gas-filled pseudocysts rather than to the widespread theory of gas-filled lymph vessels.
A case of pneumoretroperitoneum which came out to be caused by pneumatosis cystoides intestinalis, after careful and proper diagnostic evaluation, is described. Physiopathology, etiopathogenesis and clinical peculiarities of this infrequent pathology are examined; most useful tests to be performed in diagnostic differential evaluation, and clinical and surgical therapeutic approaches are also described, especially facing rare complications of PCI, such as pneumoperitoneum and pneumoretroperitoneum.
HISTORY AND CLINICAL FINDINGS: A 56-year-old man was admitted to hospital for investigation of meteorism and severe flatulence for 10 months and irregular stools. He had no previous illness. On examination his abdomen was quite distended, with very active but low-pitched peristalsis. INVESTIGATION: Plain x-ray of the abdomen showed multiple round translucencies along the wall of the left hemicolon. Coloscopy revealed multiple firm-walled cysts in the descending and sigmoid colon which contained H2 in high concentration. Histologically there was slight inflammatory infiltration of the submucosa as well as some slit-like hollow spaces, pointing to the diagnosis of pneumatosis cystoides intestinalis. The H2 breath test, done to confirm the diagnosis, indicated increased H2-concentration, both on fasting and after lactulose. TREATMENT AND COURSE: A diet low in flatulence-producing carbohydrates satisfactorily controlled the symptoms, but the local findings remained unchanged over 4 years. CONCLUSION: Pneumatosis cystoides intestinalis should be included in the differential diagnosis of meteorism and flatulence. Diet can satisfactorily control the symptoms of this rare disease.
We report three cases of pneumatosis cystoides intestinalis (PCI) occurring in association with post-surgical bowel anastomosis. A 74-year-old man, a 58-year-old woman, and a 62-year-old woman were found to have PCI at the colonic side of a bowel anastomosis at 4 years, 3 years and 1 year after operation, respectively, for right colon carcinoma, although all were asymptomatic. They all had a positive anti-nuclear antibody test and had received postoperative cancer chemotherapy. The clinical features of 123 cases of PCI reported in Japan between 1981 and 1995 were also reviewed. On the basis of the present and previous cases, we propose that post-surgical anastomosis, cancer chemotherapy, and predisposition to collagen vascular disease might be responsible for the damage to intestinal mucosa that leads to the development of PCI.
Gas in the bowel wall is an unusual but important finding on an abdominal radiograph. The so-called "benign form," pneumatosis cystoides intestinalis, may be asymptomatic or may cause a variety of symptoms and can result in a bowel obstruction or a sterile pneumoperitoneum. On the other hand, intramural intestinal gas may represent severe underlying disease such as necrotizing enterocolitis or mesenteric vascular occlusion. This finding should be sought when examining abdominal radiographs. A thorough appreciation of the clinical significance of this unusual entity is necessary to make timely therapeutic decisions.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors present the case-history of a 83-year-old patient hospitalized and operated on account of ileus caused by pneumatosis cystoides intestinalis. In the discussion the authors pay attention to the etiology, pathogenesis, clinical picture and possible treatment of this disease.
Explore the source record for details and available documents.
In the recent literature, only a few reports deal with generalized pigmentation caused by bismuth treatment. We report a patient developing generalized pigmentation of the skin and mucous membranes without further signs of chronic bismuth poisoning following long-term administration of bismuth for pneumatosis cystoides intestinalis. Bismuth deposits were documented in a skin biopsy.
The authors report a case of a large pseudocystic pheochromocytoma, which initially was operated on and histologically diagnosed as a pancreatic pseudocyst. After recurrence, a multilocular cystic tumor was found both by ultrasonography and CT. ERCP demonstrated a cut-off of the pancreatic duct. Re-operation revealed a cystic adrenal tumor anastomosed to the stomach. The operation was complicated by a hypertensive crisis and a subsequent subendocardial infarction. In the preoperative period the patient had continuous diarrhea and pneumatosis cystoides intestinalis was demonstrated by double contrast barium enema. The pneumatosis disappeared within three months but a recurrent tumor appeared. The importance of CT in the preoperative work-up of upper abdominal lesions is emphasized, as atypical cystic masses may cause differential diagnostic problems in surgery or even in localized biopsies, while CT would give a better overall view of the tumor.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Gut wall gas cysts are uncommon and are an occasional cause of abdominal symptoms. Their aetiology is uncertain and both bacterial infection and chronic airways disease are popularly held theories. At Prince Henry Hospital (PHH) between 1980 and 1986, 8 patients with pneumatosis cystoides intestinalis (PCI) underwent 11 courses of hyperbaric oxygen treatment (HBO). This is the largest reported series of HBO treatment of PCI. In April 1990 attempts were made to recall all patients to assess cyst and symptom status. Two had died from unrelated causes; the other six were reviewed--of these, one declined further endoscopy and the other five consented. The 11 courses of treatment all resulted in pronounced symptomatic responses. This was followed by 7 early symptomatic recurrences and 4 long-term cures. These four remain asymptomatic and cyst-free at a minimum of 4 years to a maximum of 9 years follow-up. Of these 4 cures, cyst resolution was documented immediately post-HBO treatment in two and not assessed in two. In the 7 recurrences, failure of cyst resolution was documented immediately post-HBO treatment in six and not assessed in one. Three patients had chronic airways disease, and two of these have complete resolution of PCI. It is concluded that HBO treatment is effective for PCI provided it is continued until cyst resolution has occurred and not just until symptomatic improvement. These observations suggest that PCI is curable and argues against the pulmonary theory of aetiology.
Explore the source record for details and available documents.
A thirty eight year old female with a long standing history of a chronic duodenal ulcer presented at the Nyeri Provincial General Hospital with vomiting, abdominal pain and abdominal distension. Oesophago-gastro-duodenoscopy revealed a tight pyloric stenosis while abdominal ultrasonography showed ascites. At laparatomy, she was coincidentally found to have pneumatosis cystoides intestinalis (PCI). The recent literature is reviewed and this case of PCI associated with ascites and pyloric stenosis secondary to a chronic duodenal ulcer is reported.