A Rare Case of Benign Pneumatosis Intestinalis with Portal Venous Gas and Pneumoperitoneum Induced by Acarbose

Rottenstreich, Amihai; Agmon, Yahel; Elazary, Ram

doi:10.2169/internalmedicine.54.4255

Cited by 16 publications

(24 citation statements)

References 15 publications

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“…Three main theories have been proposed for the pathogenesis of this condition. (6) The mechanical theory postulates that the condition develops as a result of increased intraluminal pressure which allows gas to infiltrate the bowel wall via mucosal defects. In contrast, the bacterial theory postulates that PI occurs when the submucosal localization of fermenting bacteria ( e.g ., Clostridium difficile and Escherichia coli ) leads to the production of gas that subsequently accumulates in the submucosa.…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: successful conservative management of a rare condition

Faria

Anjos

Fernandes

et al. 2016

Einstein (São Paulo)

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A 69-year-old male patient, smoker, was diagnosed with small cell lung cancer metastatic to lung, liver and central nervous system. He received chemotherapy with carboplatin AUC 5 on day 1 and etoposide 100mg/m2 on days 1, 2 and 3. During the first cycle, the patient presented with febrile neutropenia and abdominal distension. Chest, abdomen and pelvis computed tomography scan was performed and detected gas dissecting the wall of sigmoid colon extending to the mesosigmoid. Patient had no abdominal pain, nausea, vomiting, and on physical examination he had no peritoneal irritation, tachycardia or hemodynamic instability compatible with perforation or acute abdomen. Therefore, the radiological finding was interpreted as pneumatosis intestinalis caused by chemotherapy with etoposide. Pneumatosis resolved after continuous oxygen therapy. The second cycle was administered after a complete resolution of the clinical condition and etoposide dose was reduced by 30%. The patient experienced a remarkable evolution.

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Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: successful conservative management of a rare condition

Faria

Anjos

Fernandes

et al. 2016

Einstein (São Paulo)

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“…Otros nombres conocidos para esta entidad son linfoneumatosis quística, linfoneumatosis peritoneal, enfisema quístico y enfisema bulloso del intestino. Para la explicación de esta entidad existen varias teorías propuestas (2,4,7,9): la teoría mecánica sugiere que el gas se origina en la luz intestinal y se produce una disección de la pared por aumento de la presión (2,4,8); en otros casos se cree que ocurren por alteración inmune (3), medicamentos o procedimientos (9). La segunda teoría se basa en una ruptura de los alvéolos a nivel pulmonar, en el que el gas llega a la pared intestinal por el retroperitoneo y mesenterio (3,4,8,9), y la tercera teoría plantea que hay bacilos productores de gas en la submucosa de la pared intestinal (2,4,8,9).…”

Section: Neumatosis Quística Intestinalunclassified

“…Residente de Radiología de la Universidad CES. 4. Residente de Radiología de la Universidad Pontificia Bolivariana -Cedimed.…”

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Neumatosis intestinal: ¿una urgencia abdominal?

González¹,

Marquez

Zuluaga

et al. 2017

CES Med.

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Comparte ResumenEl auge de las imágenes diagnósticas, en especial de la tomografía computarizada multidetector, ha permitido que entidades poco conocidas sean detectadas con relativa frecuencia. Inicialmente, se creía que todos los pacientes con neumatosis intestinal padecían enfermedades abdominales graves o presentaban complicaciones que requerían un manejo quirúrgico inmediato, pero al conocer mejor esta entidad, en parte gracias al aumento en el número de tomografías realizadas en la práctica diaria, se ha demostrado que la neumatosis intestinal también puede presentarse en pacientes asintomáticos o asociada a entidades benignas. Es importante conocer los signos y síntomas que ayudan a diferenciar las formas benignas de neumatosis de aquellas que ponen en peligro la vida del paciente y requieren manejo quirúrgico. Presentamos dos casos de neumatosis intestinal y una revisión de la literatura que ayudarán a aclarar la presentación por imágenes y etiología de esta entidad poco conocida. Palabras clave: Neumatosis cistoide intestinal, Perforación intestinal. AbstractPenumatosis intestinalis is a clinical condition that has been increasingly detected in recent years with the escalating use of computed tomography for abdominal imaging. Previously, it was thought that all the patients cursing with penumatosis intestinalis had life threatening conditions that required immediate surgical treatment. With the increased detection of this radiologic entity, benign causes have been described for example the cystic pneumatosis intestinalis, which in the mayority of times is an isolated finding and does not require surgery. It is important to recognize the signs and symptoms that help differentiate the benign forms, from those that are life-threatening conditions and require surgery. We report two cases of pneumatosis cystoides and a review of the literature that will illustrate the imaging findings and etiology of this rare entity.

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“…A study that compared the CT findings in patients with benign or life-threatening PI showed that certain CT features, including mesenteric stranding, bowel wall thickening, and ascites, were present in more than 90% of patients with severe PI and correlated significantly with life-threatening disease [7]. Similarly, the presence of hepatoportal or portomesenteric venous gas and a linear pattern of intramural gas may predict a deleterious outcome, associated with intestinal infarction [6–8], but portal venous gas or pneumoperitoneum has been seen in a patient with benign PI [9]. In our patients, both case 1 and case 2, no obvious findings suggesting portal venous gas or pneumoperitoneum were observed.…”

Section: Case Presentationmentioning

confidence: 99%

Pneumatosis intestinalis with a benign clinical course: a report of two cases

et al. 2017

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BackgroundPneumatosis intestinalis (PI) is a rare condition characterized by the presence of gas within the gastrointestinal tract wall. Most cases of PI have a benign clinical course, although some have serious outcomes. Mechanical stress on or bacterial infection of the gastrointestinal tract wall may be responsible for the onset of PI, but the detailed mechanism of PI pathogenesis is still unclear. Here, we describe two Japanese patients presenting with benign PI.Case presentationCase 1, a 37-year-old previously healthy male patient, had a 1-week history of abdominal pain, and case 2, a 78-year-old female diabetic patient, had a 2-week history of voglibose treatment and abdominal pain. Intramural gas was mainly distributed in the colon in case 1 and in the small intestine in case 2. Interestingly, neither patient showed obvious inflammatory signs upon admission and recovered spontaneously with conservative treatment, including fasting and fluid infusion without antibiotics. Voglibose treatment was terminated in case 2. Recent studies have shown the presence of nonpathogenic bacteria, such as Clostridium spp., in PI lesions, which usually play an important role in modulating the tolerance of the gastrointestinal immune responses. The benign clinical course and spontaneous resolution of PI in these patients, without specific treatment, suggests that nonpathogenic indigenous bacteria in the gastrointestinal tract participate in the pathogenesis of PI.ConclusionIn patients with benign PI, the absence of an inflammatory response and the spontaneous resolution of the disease without specific treatment suggest the participation of nonpathogenic indigenous bacteria of the gastrointestinal tract.

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A Rare Case of Benign Pneumatosis Intestinalis with Portal Venous Gas and Pneumoperitoneum Induced by Acarbose

Cited by 16 publications

References 15 publications

Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: successful conservative management of a rare condition

Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: successful conservative management of a rare condition

Neumatosis intestinal: ¿una urgencia abdominal?

Pneumatosis intestinalis with a benign clinical course: a report of two cases

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