High flow oxygen therapy for pneumatosis coli.

Holt, S; Gilmour, H M; Buist, T. A. S.; Marwick, Katie; Heading, R C

doi:10.1136/gut.20.6.493

Cited by 34 publications

(20 citation statements)

References 19 publications

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“…[1] Given concerns for ischemia and the possibility of impending perforation, general surgery is often consulted early. However, there are multiple causes including obstruction, infarction, irritable bowel disease, intestinal neoplasms, enteritis, appendicitis, tuberculosis, adhesions, a prior end to end anastomosis, obstructive pulmonary disease, drug-induced, pyloric stenosis, immunosuppression related, trauma, or it may be idiopathic.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are multiple causes including obstruction, infarction, irritable bowel disease, intestinal neoplasms, enteritis, appendicitis, tuberculosis, adhesions, a prior end to end anastomosis, obstructive pulmonary disease, drug-induced, pyloric stenosis, immunosuppression related, trauma, or it may be idiopathic. [1,3,5] These patients may have a completely benign disease or they may be present in extremis. Patients may have the fulminant or the benign form of the disease; fulminant pneumatosis intestinalis is associated with an acute bacterial process, sepsis, and necrosis of the bowel.…”

Section: Discussionmentioning

confidence: 99%

“…The gas contained within these cysts is estimated to be 72.5%-90% nitrogen, 5%-16% oxygen, 10% hydrogen and 0.3%-4% carbon dioxide, noting free diffusion of gas between bowel lumen and capillaries. [1,6] Patients treated with high flow oxygen therapy have been noted to have radiographic resolution of their pneumatosis intestinalis in a matter of days; therapy may be administered via a head tent, hyperbaric oxygen, or a nonrebreather mask. [1,2,6] It is thought that the high concentrations of oxygen lead to denitrogenation of the blood, which inevitably eradicates the gas cysts.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] It is marked by air or gas-filled cysts within the wall of the GI tract, potentially involving the small bowel, large bowel, stomach, or esophagus, which may be subserosal and/or submucosal. [2,4] These cystic collections of gas have been recognized as early as 1730.…”

Section: Introductionmentioning

confidence: 99%

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An incidental finding of pneumatosis intestinalis: Conservative management without oxygen therapy

Kalsi

Raymond

Giuseppucci

et al. 2018

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Pneumatosis intestinalis can be identified radiographically incidentally in an asymptomatic patient, or it may be present in its fulminant form with peritonitis. Although multiple mechanisms have been postulated, most believe it arises from mechanical or infectious factors. Respiratory factors have also been described as possible causes for this condition. Clinically, it is important to differentiate among patients whom require surgical intervention from those who would benefit from conservative management, such as hyperbaric oxygen, changes in diet, and/or antibiotic administration. Although supplemental oxygen has become the standard of care for the treatment of benign pneumatosis intestinalis, we question whether all patients require oxygen therapy as a treatment. Although oxygen may be beneficial, the literature suggests there may be detrimental effects from oxygen toxicity and the free radicals formed during hyper-oxygenation. Furthermore, given the rising epidemic of antibiotic resistance and the various toxicities associated with usage of antibiotics, do all patients really require antibiotics? We present a case of a patient with complaints of hematuria, but no other gross abdominal complaints and was incidentally found to have pneumatosis intestinalis and pneumoperitoneum without any evidence of vascular compromise or ischemia. This patient was managed successfully with conservative treatment without oxygen therapy or antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An incidental finding of pneumatosis intestinalis: Conservative management without oxygen therapy

Kalsi

Raymond

Giuseppucci

et al. 2018

CSS

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“…High-flow oxygen has been reported to be effective in cases of symptomatic PCI (14). The therapeutic mechanisms underlying high-flow oxygen therapy include the following: 1) it suppresses the growth of anaerobic intestinal bacteria that contribute to intestinal pneumatosis and 2) it increases the oxygen partial pressure in the veins, which reduces the partial pressure of nonoxygen (the components of intestinal pneumatosis are nonoxygen: nitrogen, hydrogen, etc.…”

Section: Discussionmentioning

confidence: 99%

Improvements in Pneumatosis Cystoides Intestinalis and Hepatic Portal Venous Gas with Conservative Therapy in a Patient on Maintenance Dialysis

et al. 2016

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A 77-year-old man on maintenance dialysis developed hypotension, nausea and abdominal pain one hour after beginning to undergo hemodialysis. Abdominal computed tomography (CT) showed gas shadows in the intrahepatic portal vein and the small intestinal wall, but no signs indicating intestinal necrosis. Three days later, the gas shadows on abdominal CT disappeared by conservative therapy. In cases with both pneumatosis cystoides intestinalis and hepatic portal venous gas, intestinal necrosis should therefore be suspected and surgical therapy should also be considered, particularly in hemodialysis patients with a risk of intestinal ischemia. However, conservative therapy may be an option in cases with no intestinal necrosis.

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The Spectrum of Pneumatosis Intestinalis

Peter¹

2003

Arch Surg

363

362

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A review of the spectrum of illness associated with pneumatosis intestinalis enables us to identify the probable causes of, the best diagnostic approaches to, and the most appropriate treatments for this condition. Data Sources: A review of all published material in the English language regarding pneumatosis intestinalis was conducted using the PubMed and MEDLINE databases. Any relevant work referenced in those articles and not previously found or published before the limit of the search engine was also retrieved and reviewed.Study Selection: There were no exclusion criteria for published information relevant to the topic. All of the studies cited in the present review make a point that contributes to the portrayal of this condition. In circumstances in which the same point was made in several different studies, not all were cited herein.Data Extraction: All published material on pneumatosis intestinalis was considered. Information was extracted for preferentially selected ideas and theories supported in multiple studies.Data Synthesis: The collected information was organized by theory.Conclusions: Mucosal integrity, intraluminal pressure, bacterial flora, and intraluminal gas all interact in the formation of pneumatosis intestinalis. Radiography and computed tomography are the best diagnostic tests. Nonoperative management should be pursued in most patients, and underlying illnesses should be treated. When acute complications appear, such as perforation, peritonitis, and necrotic bowel, surgery is indicated.

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High flow oxygen therapy for pneumatosis coli.

Cited by 34 publications

References 19 publications

An incidental finding of pneumatosis intestinalis: Conservative management without oxygen therapy

An incidental finding of pneumatosis intestinalis: Conservative management without oxygen therapy

Improvements in Pneumatosis Cystoides Intestinalis and Hepatic Portal Venous Gas with Conservative Therapy in a Patient on Maintenance Dialysis

The Spectrum of Pneumatosis Intestinalis

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