Pneumatosis cystoides intestinalis

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare condition that may be associated with a variety of diseases. The presenting clinical picture may be very heterogeneous and represent a challenge for the clinician. In the present paper we describe both a common and an uncommon clinical presentation of PCI and review the pertaining literature. Our cases confirm that, apart from asymptomatic cases, the clinical presentation of PCI may be widely different and suggest that a new onset of stipsis might be the presenting symptom. Diagnosis might be suggested by a simple X-ray of the digestive tract showing a change in the characteristics of the intestinal wall in two-thirds of these patients. However, one third of the patients do not have a suggestive X-ray and require a computed tomography (CT) scan/nuclear magnetic resonance that may reveal a thickened bowel wall containing gas to confirm the diagnosis and distinguish PCI from intraluminal air or submucosal fat. CT also allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of PCI such as bowel wall thickening, altered contrast mucosal enhancement, dilated bowel, soft tissue stranding, ascites and the presence of portal air. Our results also point out that clinicians and endoscopists should be aware of the possible presentations of PCI in order to correctly manage the patients affected with this disease and avoid unnecessary surgeries. The increasing number of colonoscopies performed for colon cancer screening makes PCI more frequently casually encountered and/or provoked, therefore the possible endoscopic appearances of this disease should be well known by endoscopists.

Pneumatosis Intestinalis as an initial presentation of acute myeloid Leukemia

“…Pneumatosis cystoides Intestinalis (PCI) is a relatively rare condition characterized by multiple intramural gases existing in any part of the gastrointestinal tract [2]. PCI was first reported by Du Vernoy in1730 [3].…”

Pneumatosis Cystoides Intestinalis, Is the Emergency Surgery Inevitable: Case Report

“…Oxygen diffuses into the cysts and forces the other gases out into the blood. Hyperbaric oxygen at 2.5 atmosphere pressure for two hours per day can reduce the duration of oxygen therapy [9]. Endoscopic treatments like polypectomy should be avoided as it can lead to perforation and peritonitis.…”

Extensive pneumatosis intestinalis: a benign bystander

“…This theory is supported by findings of pneumatosis intestinalis in patients with respiratory diseases such as chronic obstructive pulmonary disease and asthma. 3,4 The challenge is in differentiating life-threatening pneumatosis intestinalis from benign cases, given its wide range of pathogenesis. In clinically significant pneumatosis, urgent surgical management is critical.…”