Pneumatosis cystoides coli

Abstract

images in clinical medicine T h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 361;8 nejm.org august 20, 2009 e12 A 25-year-old woman presented with recurrent abdominal pain that had first developed 10 years earlier. Physical examination revealed mild tenderness in the left upper quadrant, without rebound or guarding. Laboratory tests showed no significant abnormalities. Coronal computed tomography (CT) (Panel A) and colonoscopy (Panel B, transverse colon) showed submucosal cysts confined to the splenic flexture and the distal transverse colon (arrows in Panels A and B), which were consistent with pneumatosis cystoides coli. One year before presentation, acute pain had developed in the left upper quadrant as a result of microperforation. At that time, CT revealed a small amount of air outside the colon and associated inflammation. The patient was treated nonoperatively, with good results. Given her persistent localized symptoms and the involvement of a discrete segment of her colon, laparoscopic resection of the transverse colon and splenic flexure was performed, without complications, and the patient has been asymptom-atic since the surgery. The pathological specimen showed the characteristic features of pneumatosis cystoides coli, air-filled cysts of various sizes in the submucosa and subserosa of the colon (Panel C, arrows). Pneumatosis cystoides coli can be focal or diffuse and occurs mainly in adults. It is usually asymptomatic but can cause obstruction or pneumoperitoneum as well as intermittent or persistent pain.

Pneumatosis Intestinalis in Patients With Severe Thermal Injury

“…5,21,23,27 This fact seems to only pertain to patients who develop primary pneumatosis, whereas the small bowel is the most common site in patients who have secondary PI. 4,20,28,29 In our series, we found that PI occurred most frequently in the small and large bowel concurrently (60%) compared with only 27% isolated to the small bowel and 7% only in the large bowel. This finding is contrary to the literature, and 100% of the patients in this study developed secondary PI because of intestinal infarction.…”

High flow oxygen therapy for pneumatosis coli.

“…It is important to note that gas cysts may vary in size and extent without specific treatment and that spontaneous resolu- (Bloch, 1977;Marshak et al, 1977). Our experience indicates that intermittent high flow oxygen therapy provides a safe, comfortable, and simple form of treatment for patients with symptomatic pneumatosis coli.…”

“…It may be secondary to intestinal obstruction, infarction, inflammatory bowel disease or trauma but more frequently is of the primary idiopathic variety (Marshak etal., 1977). The pattern of the disease may have changed, as a review of the literature by Koss in 1952 identified only 13 of 213 cases of pneumatosis cystoides intestinalis with lesions restricted to the large bowel, whereas more recent reports imply a predilection for the gas cysts to occur in the left hemicolon without small intestinal involvement (Smith et al, 1958;Varano and Bonanno, 1973;Shallal et al, 1974;Wyatt, 1975;Marshak et al, 1977). Clinically, pneumatosis coli may be asymptomatic or manifest by persistent troublesome or intermittent symptoms, and in certain cases may undergo spontaneous resolution.…”

Pneumatosis intestinalis

“…12 and 13). Marshak and associates [42,43] have reported several such patients in whom pneumatosis of the left side of the colon had developed following sigmoidoscopy, with and without a mucosal biopsy. Recurrence of pneumatosis coli suggests that massive gas insufflation at colonoscopy is at least a contributing factor in the production of this rare complication.…”