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Pneumatosis cystoides intestinalis: case report and review of literature

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Abstract

Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.

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References

  1. Du Vernoy JG. Aer intestinorum tam sub extima quam intima tunica inclusus: observationes anatomicae Acad. Acient Imp Petropol. 1730;5:213–25.

    Google Scholar 

  2. Wu LL, Yang YS, Dou Y, et al. A systematic analysis of pneumatosis cystoides intestinalis. World J Gastroenterol. 2013;19:4973–8.

    Article  Google Scholar 

  3. Wang YJ, Wang YM, Zheng YM, et al. Pneumatosis cystoides intestinalis: six case reports and a review of the literature. BMC Gastroenterol. 2018;18:100.

    Article  Google Scholar 

  4. Pear BL. Pneumatosis intestinalis: a review. Radiology. 1998;207:13–9.

    Article  CAS  Google Scholar 

  5. Feczko PJ, Mezwa DG, Farah MC, et al. Clinical significance of pneumatosis of the the bowel wall. Radiographics. 1992;12:106.

    Article  Google Scholar 

  6. Goel A, Tiwari B, Kujur S, et al. Pneumatosis cystoides intestinalis. Surgery. 2005;137:659–60.

    Article  Google Scholar 

  7. Flaig TW, Kim FJ, La Rosa FG, et al. Colonic pneumatosis and intestinal perforations with sunitinib treatment for renal cell carcinoma. Invest New Drugs. 2009;27:83–7.

    Article  Google Scholar 

  8. Neesse A, Nimphius W, Schoppet M, et al. Abdominal pain following percutaneous mitral valve repair (MitraClip): Pneumatosis intestinalis (PI) of the ascending colon. Gut. 2015;64:458–94.

    Article  Google Scholar 

  9. Petrides C, Kyriakos N, Andreas I, et al. Pneumatosis cystoides intestinalis after cetuximab chemotherapy for squamous cell carcinoma of parotid gland. Case Rep Surg. 2015;2015:530680.

    PubMed  PubMed Central  Google Scholar 

  10. Rottenstreich A, Agmon Y, Elazary R. A rare case of benign Pneumatosis intestinalis with portal venous gas and pneumoperitoneum induced by Acarbose. Intern Med. 2015;54:1733–6.

    Article  Google Scholar 

  11. Yamaguchi K, Shirai T, Ueno K, et al. 12 cases of pneumatosis cystoides intestinalis with the etiological implication of trichloroethylene. Nihon Shokakibyo Gakkai Zasshi. 1983;80:1659.

    CAS  PubMed  Google Scholar 

  12. Devgun P, Hassan H. Pneumatosis cystoides intestinalis: a rare benign cause of pneumoperitoneum. Case Rep Radiol. 2013;2013:353245.

    PubMed  PubMed Central  Google Scholar 

  13. Natarajan D. Primary PCI for acute anterior wall MI with pulmonary edema and left anterior descending artery ostial stenosis. Indian Heart J. 2010;62:90–1.

    PubMed  Google Scholar 

  14. Yale CE, Balish E, Wu JP. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg. 1974;109:89–94.

    Article  CAS  Google Scholar 

  15. Galm O, Fabry U, Adam G, et al. Pneumatosis intestinalis following cytotoxic or immunosuppressive treatment. Digestion. 2001;64:128–32.

    Article  CAS  Google Scholar 

  16. Hashimoto S, Saitoh H, Wada K, et al. Pneumatosis cystoides intestinalis after chemotherapy for hematological malignancies: report of 4 cases. Intern Med. 1995;34:212–5.

    Article  CAS  Google Scholar 

  17. Candelaria M, Bourlon-Cuellar R, Zubieta JL, et al. Gastrointestinal pneumatosis after docetaxel chemotherapy. J Clin Gastroenterol. 2002;34:444–5.

    Article  Google Scholar 

  18. Shih IL, Lu YS, Wang HP, et al. Pneumatosis coli after etoposide chemotherapy for breast cancer. J Clin Oncol. 2007;25:1623–5.

    Article  Google Scholar 

  19. St Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intestinalis. Arch Surg. 2003;138:68–75.

    Article  Google Scholar 

  20. Tsujimoto T, Shioyama E, Moriya K, et al. Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: a case report and review of the literature. World J Gastroenterol. 2008;14:6087–92.

    Article  Google Scholar 

  21. Horiuchi A, Akamatsu T, Mukawa K, et al. Case report: pneumatosis cystoides intestinalis associated with post-surgical bowel anastomosis: a report of three cases and review of the Japanese literature. J Gastroenterol Hepatol. 1998;13:534–7.

    Article  CAS  Google Scholar 

  22. Kim KM, Lee CH, Kim KA, et al. CT colonography of pneumatosis cystoides intestinalis. Abdom Imaging. 2007;32:602–5.

    Article  Google Scholar 

  23. Dawe N, Akhtar S. Pneumatosis intestinalis presenting with a pneumoperitoneum in a patient with chronic bronchiectasis: a delayed diagnosis of superior mesenteric artery ischaemia. BMJ Case Rep. 2010. https://doi.org/10.1136/bcr.01.2010.2622

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rennenberg RJ, Koek GH, Van Hootegem P, et al. Pneumatosis cystoides intestinalis, four cases of a rare disease. Neth J Med. 2002;60:22–5.

    CAS  PubMed  Google Scholar 

  25. Castro-Pocas F, Araujo T, Pedroto I. Endoscopic ultrasound of pneumatosis cystoides intestinalis. Endoscopy. 2015;47:E274.

    Article  Google Scholar 

  26. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007;188:1604–13 (Review).

    Article  Google Scholar 

  27. Olson DE, Kim YW, Ying J, et al. CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology. 2009;253:513–9.

    Article  Google Scholar 

  28. Schindera ST, Triller J, Vock P, et al. Detection of hepatic portal venous gas: its clinical impact and outcome. Emerg Radiol. 2006;12:164–70.

    Article  Google Scholar 

  29. Ng DW, Chia CS, Tan GH, et al. A case of portomesenteric venous gas found with extensive secondary pneumatosis intestinalis in the small bowel, stomach and distal oesophagus on radiographic images with an insidious presentation. Clin J Gastroenterol. 2014;7:140–3.

    Article  Google Scholar 

  30. Lee KS, Hwang S, Hurtado Rúa SM, et al. Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. AJR Am J Roentgenol. 2013;200:1042–7.

    Article  Google Scholar 

  31. Danse EM, Van Beers BE, Gilles A, et al. Sonographic detection of intestinal pneumatosis. Eur J Ultrasound. 2000;11:201–3.

    Article  CAS  Google Scholar 

  32. Sato M, Ishida H, Konno K, et al. Sonography of pneumatosis cystoides intestinalis. Abdom Imaging. 1999;24:559–61.

    Article  CAS  Google Scholar 

  33. Goske MJ, Goldblum JR, Applegate KE, et al. The “circle sign”: a new sono- graphic sign of pneumatosis intestinalis—clinical, pathologic and experimental findings. Pediatr Radiol. 1999;29:530–5.

    Article  CAS  Google Scholar 

  34. Rabushka LS, Kuhlman JE. Pneumatosis intestinalis: appearance on MR examination. Clin Imaging. 1994;18:258–61.

    Article  CAS  Google Scholar 

  35. Khalil PN, Huber-Wagner S, Ladurner R, et al. Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res. 2009;14:231–9.

    Article  Google Scholar 

  36. Tak PP, Van Duinen CM, Bun P, et al. Pneumatosis cystoides intestinalis in intestinal pseodoobstruction: Resolution after therapy with metronidazole. Dig Dis Sci. 1992;37:949–54.

    Article  CAS  Google Scholar 

  37. Forgacs P, Wright PH, Wyatt AP. Treatment of intestinal gas cysts by oxygen breathing. Lancet. 1973;1:579–82.

    CAS  PubMed  Google Scholar 

  38. Feuerstein JD, White N, Berzin TM. Pneumatosis intestinalis with a focus on hyperbaric oxygen therapy. Mayo Clin Proc. 2014;89:697–703.

    Article  Google Scholar 

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Acknowledgements

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy

    Marco Di Pietropaolo, Margherita Trinci, Carlo Giangregorio & Michele Galluzzo

  2. Department of Radiology, Careggi University Hospital, L. go Giovanni Alessandro Brambilla 3, 50134, Florence, Italy

    Vittorio Miele

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  1. Marco Di Pietropaolo
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  2. Margherita Trinci
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  3. Carlo Giangregorio
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  4. Michele Galluzzo
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  5. Vittorio Miele
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Correspondence to Marco Di Pietropaolo.

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Marco Di Pietropaolo, Margherita Trinci, Carlo Giangregorio, Michele Galluzzo and Vittorio Miele declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Di Pietropaolo, M., Trinci, M., Giangregorio, C. et al. Pneumatosis cystoides intestinalis: case report and review of literature. Clin J Gastroenterol 13, 31–36 (2020). https://doi.org/10.1007/s12328-019-00999-3

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  • DOI: https://doi.org/10.1007/s12328-019-00999-3

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