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Pneumatosis Cystoides Intestinalis. Pneumatosis Cystoides Intestinalis is usually associated with intrinsic disease of the bowel. A case of the ileum associated with duodenal ulcer and a case of the large bowel associated with diverticular disease are reported. It was an unexpected finding in both patients. The histiocytic origin of the cells which line the gas cysts and the pathogenesis are discussed.
Pneumatosis cystoides intestinalis (PCI) is a rare entity in which gas filled cysts are found within the intestinal wall. Conservative management and the treatment of underlying illnesses are recommended in most patients and surgery is usually indicated when acute and life-threatening complications such as bowel necrosis, perforation or peritonitis appear. The authors report a case of idiopathic pneumatosis cystoides intestinalis which, after repeated failure of conservative treatment including the oxygen therapy in hyperbaric chamber, was successfully treated by laparoscopic subtotal colectomy. A laparoscopically assisted approach proved to be a good indication in subtotal colectomy in cases of PCI that are non-responsive to standard conservative treatment.
Pneumatosis cystoides intestinalis is an uncommon condition of previously unknown etiology. Experimental work is discussed which proves that either one of at least two clostridial species can produce PCI after relatively atraumatic contamination of the peritoneal cavity of germfree animals. This work strongly supports the bacterial etiology of PCI. It further suggests that vigorous and early treatment be directed toward control of the clostridial organisms in those cases where fulminating conditions associated with PCI are present.
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts of varying size within the intestinal wall. Although the characteristic findings on plain abdominal radiograph, computed tomography (CT), and barium enema have been well described, the sonographic findings have not. We recently encountered a case of PCI in which abdominal sonography disclosed a unique finding. We were able to reproduce the finding experimentally and have coined it the "aurora sign".
Pneumatosis cystoides intestinalis (PCI) is an uncommon condition of unknown aetiology. Bacterial gas production may be an important aetiological factor, but experimental evidence in humans has been lacking. We have studied breath hydrogen excretion as an index of bacterial gas production in 12 patients with PCI and have shown that four out of five with demonstrable cysts produced unusually high levels of hydrogen while fasting. This abnormality has not been previously reported. One patient showed resolution of PCI after antibiotic treatment. These findings confirm the importance of bacterial gas production in the pathogenesis of PCI.
Pneumatosis cystoides intestinalis (PCI) is a disease characterized by retention of gas in the intestinal wall. Retention of gas can be caused by three mechanisms; gas entry through the intestinal mucosa, gas dissection from the pulmonary alveoli and bronchi, and gas generation in the mucous membrane. Since gas in cysts is composed almost entirely of nitrogen, hyperbaric oxygen therapy (HBO2) is effective for treating PCI due to the oxygen windows effect. However, PCI, caused by a mechanism involving pulmonary alveoli or branches, can become aggravated by HBO2. Therefore, we propose modifying HBO2 protocols for cases that do not require an invasive treatment. This study describes favorable results obtained in 2 PCI cases after HBO2 therapy according to our protocol.
Pneumatosis cystoides intestinalis (PCI) is an uncommon disease of previously unknown etiology, characterized by the presence of gas-filled cysts in the walls of some portion of the gastrointestinal tract. This investigation showed that PCI was readily produced in the germfree rat by inoculating its peritoneal cavity with a pure culture of either C. perfringens or C. tertium. Similar inoculation of the germfree animal with any one of eight other clostridia species did not result in the formation of PCI. The bacterial theory for the formation of at least some cases of PCI is now established. This work suggests that part of the treatment of those fulminating diseases known to be frequently associated with PCI should be directed at controlling a possible clostridial infection.
Pneumatosis cystoides intestinalis (PCI) is a relatively rare benign condition, and its sonographic findings have rarely been reported. We report on four cases of PCI in which sonography showed multiple immobile linear or spotty high echoes in the thickened colonic wall. These sonographic findings were more clearly visualized by using high-frequency probes and helped in establishing the diagnosis. In addition, color Doppler sonography confirmed the absence of portal gas and helped rule out fulminant PCI. When encountering patients with abundant abdominal gas, the possibility of PCI should be considered and the colonic wall and the portal vein should be meticulously observed by high-frequency probe and color Doppler sonography to prevent a delay in the diagnosis and to improve patient management.
Pneumatosis cystoides intestinalis (PCI), which is characterized by the presence of multiple gas-filled mucosal, submucosal, or subserosal cysts located throughout the colon and/or small intestine, is an unusual complication of systemic lupus erythematosus (SLE). We report a case of a 33-year-old woman with a 5-year history of SLE with PCI. Her symptoms improved with conservative management. Although PCI is a rare manifestation of SLE, clinicians should be alert to the differential diagnosis of this complication.
In pneumatosis cystoides intestinalis the air sacs are generally small and the mesentery is rarely involved. We describe a 23-year-old woman with mixed connective tissue disease and known esophageal ulcer who developed hematemesis and abdominal distention. Colonoscopy showed pneumatosis coli. A computed tomography (CT) scan showed a 23 cm gas-filled mass, presumably a mesenteric bulla. A conservative approach was elected and the patient's gastrointestinal symptoms improved though there was no change in the size of the bulla 3 weeks later.
Primary pneumatosis cystoides intestinalis (PCI) is an uncommon, usually benign condition whose natural course is poorly understood and which can sometimes produce significant changes in a patient's cecum and sigmoid colon. In this study, PCI was produced by monocontaminating the peritoneal cavities of adult germfree rats with Clostridium perfringens. These animals were then observed for up to 26 weeks. PCI took up to two weeks to develop, lasted at least ten weeks in most animals, and presumably disappeared from 42% of 26 animals killed during the final 16 weeks. PCI was usually benign, but in some animals produced extensive and persistent subserosal and submucosal air cysts of the cecum and sigmoid colon without evidence of intra-abdominal sepsis. These profound segmental colonic lesions suggest a possible etiology for other segmental inflammatory bowel diseases.
Pneumatosis cystoides intestinalis (PCI) is a rare disease usually occurring in association with a large variety of gastrointestinal (GI) and non GI conditions in the majority of cases, although idiopathic PCI is also known to occur. There are two theories regarding the development of these intramural gas cysts--the mechanical and bacterial theories. PCI usually runs a benign course, although fulminant PCI can be present both in infants and adults. The importance of this condition for the surgeon lies in its early recognition, in order to prevent unnecessary surgical intervention, especially when pneumoperitoneum without clinical evidence of peritonitis is encountered. Oxygen therapy has been shown to lead to regression of PCI, although recurrences have been reported. Elemental diets and antimicrobial agents have provided symptomatic relief in a few reported cases. The association of PCI with a wide variety of conditions leads us to conclude that PCI may not be a disease in itself, but a sequel to these varied conditions.
BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is characterized by high levels of breath hydrogen. Clinical features of PCI may be due to abnormal H2 metabolism. METHODS: Breath levels of H2 and CH4 were measured in 3 patients and total gas in 2 patients with PCI on a polysaccharide-free (basal) diet and after administration of 15 g of lactulose. Metabolic activities and counts of methanogenic (MB) and sulfate-reducing (SRB) bacteria were measured in feces. Ten volunteers were also studied. RESULTS: Total H2 levels in patients were 383-420 mL/day on the basal diet and 1430-1730 mL/day after lactulose administration compared with 35 +/- 6 mL/day and 262 +/- 65 mL/day, respectively, in controls. Basal breath H2 levels in controls were 27 +/- 6 vs. 214 +/- 27 mL/day in patients and after lactulose ingestion, 115 +/- 18 vs. 370 +/- 72 mL/day. Four controls were methanogenic and had high fecal MB counts. The other controls had high SRB counts and sulfate reduction rates. All patients were nonmethanogenic and had low sulfate reduction rates. CONCLUSIONS: Patients with PCI excrete more H2 than controls. In normal subjects, H2 is consumed by MB or SRB; the activity of these bacteria is virtually absent in PCI. This may explain the gas accumulation in these patients.
Pneumatosis cystoides intestinalis is a rare disease characterized by presence of multilocular cysts in the gastrointestinal wall. Idiopathic and secondary forms of the disease can be distinguished. There are presented several theories explaining pneumatogenesis in this article. The specific and non-specific symptoms are described. Attention is drawn to the pneumoperitoneum without signs of peritoneal irritation, what is a typical complication of this disease. The suspicion of pneumatosis cystoides intestinalis may be based on plain abdominal X-ray, and is usually confirmed by computer tomography or magnetic resonance imaging. The therapy can be conservative or surgical. In conclusion, although pneumatosis cystoides intestinalis is a rare disease, it may represent a problem in differential diagnosis of abdominal pain.
Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cysts in the submucosa or subserosa of the gastrointestinal tract. PCI has been described by various radiographic methods but its laparoscopic features have not been previously described. We report a case of a 77-yr-old male with marked ascites and radiographic evidence of pneumatosis cystoides intestinalis of the ileum who underwent a laparoscopy to determine the cause of his ascites. The characteristic laparoscopic features of PCI are described, and its radiographic features are reviewed.
Pneumatosis cystoides intestinalis (PCI) is a rare benign condition affecting portions of the intestinal tract, characterised by: multiple subserosa and submucosal gas cysts, unknown aetiology, and non specific clinical presentation. Its diagnosis is often coincidental. Management of PCI entails that of the associated condition.
This paper describes pneumatosis cystoides intestinalis in association with colo-colic intussusception in a young teenager. The intussusception was easily reduced at barium enema. The recognition of the characteristic filling defects in the barium column facilitates a correct diagnosis. This association has only been reported previously in six adults.
The relationship between pneumatosis cystoides intestinalis (PCI) and occupation was studied in 66 patients reported in Japan during a 5-yr-period from 1979-1983. Information concerning their occupation was obtained from 37 (56.1%) patients; 16 patients had secondary PCI and 21 had primary PCI. No particular characteristics were noted in the occupations of secondary PCI patients. Primary PCI, occurring more frequently in females (15/21), affected predominantly the large intestine (20/21), locally involving the sigmoid colon in the majority (14) of the patients. Most patients with primary PCI (16/21) were factory workers, of whom 15 (71.4%) were engaged in degreasing of manufacturing products with trichloroethylene. The high percentage of trichloroethylene workers among the patients with primary PCI suggests that occupational exposure to this agent constitutes an etiological factor in the development of this disease.