Abstract
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 antimicrobila 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.
Similar content being viewed by others
References
Koss LG (1952) Abdominal gas cysts (pneumotosis cystoides intestinorum hominis). Arch Pathol 53:523–549
Forgacs P, Wright PH, Wyatt AP (1973) Treatment of intestinal gas cysts by oxygen breathing. Lancet 1:579–582
Galandiuk S, Fazio VW, Petras RE (1985) Pneumatosis cystoides intestinalis in Crohn's disease. Report of two cases. Dis Col Rect 28:951–956
Galandiuk S, Fazio VW (1986) Pneumatosis cystoides intestinalis. A review of the literature. Dis Colon Rectum 29:358–363
Marshak RH, Blum SD, Eliasoph J (1956) Pneumatosis involving the left side of the colon. JAMA 161:1626
Keyting WS, McCarver RR, Kovarik JL, Daywitt AL (1962) Pneumatosis intestinalis: a new concept. Radiology 76:733–741
Gharhemani GG, Port RB, Beachley MC (1974) Pneumatosis coli in Crohn's disease. Am J Dig Dis 19:315–323
Menguy R (1976) Pneumatosis intestinalis after jejunoileal bypass: etiological mechanism in one case. JAMA 236:1721–1723
Martyak SN (1976) Pneumatosis intestinalis: a complication of jejunoileal bypass. JAMA 235:1038–1039
Nelson SW (1972) Extraluminal gas collections due to diseases of the gastrointestinal tract. AJR 155:225–248
Smith BH, Welter LH (1967) Pneumatosis intestinalis. Am J Clin Pathol 48:455–465
Wood RE, Herman CJ, Johnson KW, di Sant'Agnese PA (1975) Pneumatosis coli in cystic fibrosis. Am J Dis Child 129:246–248
Elliott GB, Elliott KA (1963) The roentgenologic pathology of so called pneumatosis cystoides intestinalis. Am J Roentgenol Radium Ther Nucl Med 98:720–729
Hermanz-Schulman M, Kirkpatrick J Jr, Shwachmann H, Hermann T, Schulmann G, Vawter GF (1986) Pneumatosis intestinalis in cystic fibrosis. Radiology 160:497–499
Hughes DT, Gordon KC, Swann JC, Bolt GL (1966) Pneumatosis cystoides intestinalis. Gut 7:553–557
Yale CE (1975) Etiology of pneumatosis cystoides intestinalis. Surg Clin North Am 55:1297–1302
Yale CE, Balish E (1976) Pneumatosis cystoides intestinalis. Dis Colon Rectum 19:107–111
Yale CE, Balish E, Wu JP (1974) The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg 109:89
Goodall RJR (1978) Pneumatosis coli: report of two cases. Dis Col Rect 21:61–65
Masterson JST, Fratkin BL, Osler TR, Trapp WG (1978) Treatment of pneumatosis cystoides intestinalis with hyperbaric oxygen. Ann Surg 107:245–247
Reyna R, Soper RT, Condon RE (1973) Pneumatosis intestinatinalis: Report of twelve cases. Am J Surg 115:225–248
Holt S, Gilmour HM, Buist TAS, Marwick K, Heading RC (1979) High flow oxygen therapy for pneumatosis coli. Gut 20:493–498
Breiter J, Levine JB, Forouhar FA (1982) Pneumatosis cystoides intestinalis associated with refractory sprue. Am J Gastroenterol 77:332–325
Balmaseda MT Jr, Lagattuta FP, Tugaeou JF (1987) Pneumatosis cystoides intestinalis in quadriplegia: a case report. Arch Phys Med Rehabil 68:563–565
Jackson JE, Thomas AMK (1987) The case of the bloated nurse. BJR 60:721–722
Mueller CF, Morehead R, Alter AJ, Michener W (1972) Pneumatosis intestinalis in collagen disorders. AJR 115:300–305
Fischer TJ, Cipel L, Stiehm ER (1978) Pneumatosis intestinalis associated with fatal childhood dermatomyositis. Pediatrics 61:127–130
Yamaguchi K, Shirai T, Shimakura K, Akamatsu T, Nakama H, Kono K, Sahato M, Shigeno T, Furuta S, Nakajiama T, Sato A (1985) Pneumatosis cystoides intestinalis and trichlorethylene exposure. Am J Gastroenterol 80:753–757
Borns PF, Johnston TA (1973) Indolent pneumatosis of the bowel wall associated with immune suppressive therapy. Ann Radiol 16:163–166
Janssen DA, Kalayoglu M, Sollinger HW (1987) Pneumatosis cystoides intestinalis following lactulose and steroid treatment in a liver transplant patient with an intermittently enlarged scrotum. Transpl Proc 19:2949–2952
Roscher AA, Endlich HI (1972) Pneumatosis cystoides intestinalis: clinical-pathological correlation. Int Surg 57:623–629
Thien SL, Asquith P (1977) Pneumatosis coli: complication of practolol. Br Med J 1:268
Van der Jagt EJ, van Son WJ, van der Woude FJ, Meijer S, Slooff MJ, Tegzess AM (1987) Pneumatosis cystoides intestinalis related to cytomegalo-virus infection ... a new etiology? Eur J Radiol 7:28–29
Van Son WJ, van der Woude FJ, van der Jagt EJ, Douher AJ, Meiju S, Slooff MJ, The TH, Tegzess AM, van der Slikke LB (1985) Pneumatosis intestinalis in patients after cadaveric kidney transplantation: possible relationship with an active cytomegalo virus infection. Proc Eur Dial Transplant Assoc Eur Ren Assoc 21:936–940
Sutton DH, Poskitt KR (1984) Pneumatosis cystoides intestinalis. Nitrous oxide anaesthesia and the rapid effect of oxygen therapy. Anaesthesia 39:776
Van Son WJ, van der Jagt EJ, van der Woude FJ (1984) Pneumatosis intestinalis in patients after cada veric kidney transplantation. Transplantation 38:506–510
Lewis Wall L, Linshaw MA, Bailie MD, Pierce GE (1982) Pneumatosis intestinalis in a pediatric renal transplant patient. Pediatrics 101:745–747
Galal O, Osse G, Weigel W, Gahr M (1981) Pneumatosis intestinalis in children with leukaemia: report of three cases. Eur J Pediatr 137:91–93
Thomson WO, Gillespie G, Blumgart LH (1977) The clinical significance of pneumatosis cystoides intestinalis: a report of 5 cases. Br J Surg 64:590–592
Shallal JA, Van Heerden JA, Bartholomew LG, Cain JC (1974) Pneumatosis cystoides intestinalis. Mayo Clin Proc 49:180–184
Underwood JW, Finnis D, Scott W (1978) Pneumatosis coli: a familial association. Br J Surg 65:64–65
Broecker BH, Moore EE (1977) Pneumoperitoneum due to pneumatosis cystoides intestinalis in idiopathic megacolon. JAMA 237:1963–1964
Murphy BJ, Weinfeld A (1987) Innocuous pneumatosis intestinalis of the right colon in renal transplant recipients. Report of three cases. Dis Col Rect 30:816–819
Vernacchia FS, Jeffrey RB, Laing FC, Wing VW (1985) Sonographic recognition of pneumatosis cystoides intestinalis. AJR 145:51–52
Candill JL, Rose BS (1987) The role of computed tomography in the evaluation of pneumatosis intestinalis. J Clin Gastroenterol 9:223–226
Watson RDS (1976) Successfull treatment of pneumatosis coli with oxygen. Br Med J 1:199–200
Hoflin F, Van der Linden W (1974) Pneumatosis cystoides intestinalis treated by oxygen breathing. Scand J Gastroenterol 9:427–430
Wyatt AP (1975) Prolonged symptomatic and radiological remission of colonic gas cysts after oxygen therapy. Br J Surg 62:837–839
Ellis BW (1980) Symptomatic treatment of primary pneumatosis coli with metronidazole. Br Med J 280:763–764
Janhonen P, Lehtola J, Karttunen T (1987) Treatment of pneumatoses coli with metronidazole — endoscopic follow-up of one case. Dis Colon Rectum 30:800–801
Wandtke J, Skucas J, Spataro R, Bruneau RJ (1977) Pneumatosis intestinalis as a complication of jejunoileal bypass. Am J Roentgenology 129:601–604
Holt S, Stewart IC, Heading RC, Macpherson AIS (1978) Resolution of primary pneumatosis coli. J R Coll Surg Edin 23:297–299
Van der Linden W, Marsell R (1979) Pneumatosis cystoides coli associated with high H2 excretion: treatment with elemental diet. Scand J Gastroenterol 14:173–174
Case WG, Hall R (1985) Surgical treatment of pneumatosis coli. Ann R Col Surg Engl 67:368–369
Elidan J, Goldschmidt ZG, Schwartz A (1980) Pneumoperitoneum induced by pneumatosis cystoides intestinalis associated with volvulus of stomach. Am J Gastroenterol 74:189–195
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rogy, M.A., Mirza, D.F., Kovats, E. et al. Pneumatosis cystoides intestinalis (PCI). Int J Colorect Dis 5, 120–124 (1990). https://doi.org/10.1007/BF00298485
Issue Date:
DOI: https://doi.org/10.1007/BF00298485