A case of pneumatosis intestinalis during neoadjuvant chemotherapy with cisplatin and 5-fluorouracil for esophageal cancer†

Abstract

Pneumatosis intestinalis (PI) is a relatively rare disease. A 70-year-old man with stage II squamous cell carcinoma of the middle thoracic esophagus was administered cisplatin plus 5-fluorouracil (CF) therapy as neoadjuvant chemotherapy. On Day 14 of the first course of CF therapy, he complained of acute abdominal pain. Computed tomography (CT) revealed PI of the entire colon and a small air bubble in the mesentery. A colonoscopy revealed that there was no finding suggestive of ischemia. Because there was no sign of peritoneal irritation, conservative treatment was selected. On Day 7 after PI diagnosis, CT indicated the disappearance of PI. The patient underwent a radical esophagectomy. Intraoperative laparoscopic findings showed the serosa of the colon to be intact. The patient was discharged without any complications. It is important to take into account that CF therapy may cause PI and that PI can be treated conservatively.

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

“…All titles were screened, after which 65 full-text articles were assessed for eligibility. Ultimately, 50 records that met our eligibility criteria were identified, and 12 more reports were retrieved through reference mining, reaching a total of 62 articles that were included in our systematic review ( Figure 2 ) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 62 , 64 , 65 , 67 , 68 , 69 , ...…”

“…Among adult patients, secondary PI is mainly associated with gastrointestinal disease, pulmonary diseases, mechanical ventilation, endoscopic procedures, infections and other immunological conditions [ 8 ]. Medications used for cancer treatment are among the most recognized causes of PI, including cytotoxic chemotherapeutic agents [ 9 ] and molecular targeted agents [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

Pneumatosis intestinalis: cost paid for rheumatoid arthritis treatment

“…Serial imaging is very important to monitor the progression of pneumatosis especially when the patients are being managed conservatively. High index of suspicion is essential to select patients who require vigorous management over patients who can be managed conservatively as PI could be a benign finding in patients who are getting chemotherapy 12…”

Man with Acute Abdomen

“…The causes may be gastrointestinal, (e.g., inflammatory bowel disease, ischaemic bowel disease, intestinal obstruction), non-gastrointestinal (e.g., medication-induced by chemotherapy or other immunosuppressive drugs), pulmonary diseases, iatrogenic (post endoscopy), or idiopathic. 2 …”