Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature

Abstract

Pneumatosis coli is a rare condition characterised by multiple gas-filled cysts within the bowel wall. We present 25 cases treated over the past 30 years. The patients' mean age was 59 years: 15 were female. Presenting symptoms included diarrhoea (n = 17), mucus discharge (n = 17), rectal bleeding (n = 15) and constipation (n = 12). Pneumatosis usually affected the left colon (96%), and diagnosis was by sigmoidoscopy and biopsy in 18 cases (72%). Pneumatosis coli was associated with psychiatric disorders (36%), chronic lung disease (20%) and colitis (12%). A redundant sigmoid colon was observed in 80% of cases on contrast radiology. Five patients had mucosal pseudolipomatosis on histological examination. Histological and immunohistochemical review indicated that the cysts were lined by cells of macrophage/monocyte phenotype and that many similar mononuclear cells were present in the adjacent submucosa and overlying mucosa. Treatment with antidiarrhoeals and anti-inflammatory drugs in 14 patients resulted in improvement in 9 cases (64%). Oxygen therapy (n = 9) always alleviated symptoms. There was a high recurrence rate (50-78%), but with further courses of therapy lasting remission was achieved in five patients. Two patients underwent colectomy. The associations of pneumatosis coli with psychiatric disorders and mucosal pseudolipomatosis are new and of possible pathogenetic significance. A novel pathogenetic mechanism is suggested to explain the association of pneumatosis coli and chronic respiratory disorders. A model of pneumatosis coli linking some of the apparently disparate pathogenetic theories is proposed.

Intussusception Secondary to Pneumatosis Intestinalis: A Rare Case Report

“…The Bacterial theory explains that, submucosal localization of fermenting bacteria like E.coli and clostridia leads to production of gas which is retained by the submucosa and lymphatic channels. (8) In our case, PI may be due to colonic bacterial overgrowth. There is no characteristic clinical presentation of PI.…”

“…The exact etiology of the PI is still unknown. PI may be due to colonoscopies, (6) ileal surgery, (7) chronic pulmonary disease, (8) connective tissue disorder, (9) and ingestion of lactulose/sorbitol. (10,11) In our case, the etiology was also unknown.…”

Colonic pneumatosis intestinalis in a patient with neutropenia secondary to anorexia nervosa

“…The etiology has not yet been elucidated, but generally it is associated with a systemic disease (1)(2)(3)(4). Colonic pneumatosis represents about 30% of gastrointestinal cases (1).…”

Medical management of pneumatosis intestinalis in patients undergoing allogeneic blood and marrow transplantation

“…13 PI traditionally has been managed surgically with a high mortality rate (33-44%). [14][15][16] On the basis of our own suboptimal results with surgical intervention, we managed these patients conservatively with the addition of antianaerobic bacterial therapy to bowel rest and total parental nutrition (TPN). We present the results of non-surgical management.…”