“Cystamatic” Review: Is Surgery Mandatory for Pneumatosis Cystoides Intestinalis?

Abstract

Introduction Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the small and large intestines. We describe a case of a 70-year-old man admitted to the Emergency Surgery Department for PCI who was treated conservatively. Areas Covered We reviewed 60 cases of PCI described in the international literature over the last 5 years. From our analysis, it appears that the etiology of the gas production within the submucosa or the subserosa of the gastrointestinal tract is still unknown. The rupture of the cysts can lead to pneumoperitoneum that can simulate a surgical emergency. Expert Commentary For patients with PCI, a conservative approach is the treatment of choice, with surgery mandatory only for complicated disease. Keywords Pneumatosis cystoides intestinalis • Conservative management • Spontaneous pneumoperitoneum Abbreviations CTComputed tomography scan PCI Pneumatosis cystoides intestinalis COPD Chronic obstructive pulmonary disease Case Report and EvolutionA 70-year-old man was admitted to the Emergency Department of St. Orsola University Hospital-Bologna-due to the onset of abdominal pain associated with rectorrhagia. His past medical history included hypertension, atrial fibrillation treated with oral anticoagulants, an episode of stroke with dysphagia and dysarthria, cerebrovascular disease, nephrectomy for renal cancer, and diabetes mellitus. In the emergency department, physical examination, blood tests, and chest X-ray were performed. Physical examination was remarkable for upper abdominal direct tenderness in the * A. Lauro

Case Report: An unusual case of small bowel volvulus associated with pneumatosis intestinalis

“…So that their presence should not be always regarded as signs of severity. 13,15,16 Moreover, according to literature, the rare findings of PCI and PVG can be present in asymptomatic patients without ominous signs, as described in the series of Sooby et al, 17 including 88 patients with PCI/PVG of which 19 with benign PCI, and of these 19, 6 patients had both PCI and PVG. These patients were put under surveillance, and they had no uneventful recovery.…”

“…8,9 Incidentally PCI can induce surgical complications such as bowel obstruction, intestinal perforation, volvulus, intussusception, and bleeding, which require surgical intervention. 13 Intestinal obstruction can be a rare complication of PCI. This event depends on the size and number of the cysts which lead in certain cases to a reduction of the intestinal lumen, volvulus, perforation, and hemorrhage.…”

Pneumatosis Intestinalis: To Biopsy or Not to Biopsy?

“…Despite first being described in French literature in 1754 by Duvernoy [4], it is still poorly understood. A few theories of its pathogenesis have been proposed [5]. In the mechanical theory, gas enters the bowel wall from the intestinal lumen in times of increased intraluminal pressure; for example, when there is intestinal obstruction due to a gastrointestinal tumor.…”

“…The bacterial theory involves gas-forming bacteria invading the submucosa in times of increased mucosal permeability and producing gas in the intestinal wall. Similarly, the chemical and nutritional theory involves increased gas production due to bacterial fermentation of carbohydrates, which penetrates the intestinal wall [5]. Inflammation, physical damage of the intestinal mucosa, gastrointestinal dysmotility, and immune dysfunction may play a role as well [6].…”

Pneumatosis intestinalis and spontaneous perforation associated with drug toxicity in oncologic patients : a case series

“…As such drugs target kinases which are not always differentially expressed by endothelial cells, they might affect not only the activated tumour endothelium but also normal vasculature, thus leading to specific toxicities (10). Assoun et al noted that 42.2% of oncologic patients treated with VEGF inhibitors developed gastrointestinal adverse effects, mainly as digestive perforations requiring an admission to an intensive care unit as life-threatening condition, including a case specifically engaging the administration volvulus, and gastrointestinal bleeding thus leading to urgent surgery due to their high mortality risk (4).…”