Pneumatosis cystoides intestinii

Abstract

Pneumatosis cystoides intestinalis (PCI), a condition involving submucosal or subserosal gas-containing cysts of the wall of the gastrointestinal tract, is a rare entity. It is mostly diagnosed between the third and fifth decades of life without a clear sexual predominance. Different aetiopathogenetic factors are under discussion, the most probable being a bacteriologic cause (Clostridium perfringens) in combination with minimal leaks in the mucosal barrier. There are no pathognomonic symptoms; the clinical picture ranges from incidental findings to haematochezia. Diagnosis is based on plain abdominal film and X-ray following barium enema. Methods of treatment in symptomatic cases are oxygen and antibiotic (metronidazole) therapies and, in severe cases, resection of the diseased part of the intestine.

Pneumatosis Cystoides Intestinalis - A Review

“…Beyond infancy the PCI is rare (44). In Bertram's et al (7) opinion the period with the most frequent incidence of PCI is age between 30 and 50 years, a clear sexual predominance doesn't exist.…”

“…This theory is supported by experiments in rats, where PCI was induced by Clostridium perfringens (52). The microorganisms playing role in origin of PCI are Clostridium difficile, cytomegalovirus (44) or Clostridium perfringens (7).…”

“…There are seen the cysts in the bowel wall or free air under diaphragm in the case of their rupture and pneumoperitoneum appearance. The next diagnostic method can be represented by barium enema examination (7,40). Further it is possible to complete other investigations, which are more sensitive but also more expensive.…”

“…The causal therapy includes ways suppressing supposed etiological mechanisms. Inhibition principles of these mechanisms consist either in restriction of intestinal gas producting microflora -administration of antibiotics, es-pecially metronidazol (7,29,31,47), or in inhibition of process leading to the hydrogen hyperproduction -hyperbaric oxygen inhalation (7,31,42). In another way of treatment there is possible to include a diet low in flatulence-producing carbohydrates (14), parenteral nutrition (29,31), endoscopical puncture and cysts sclerotherapy (25), therapy with long-acting somatostatin analogue (30).…”

“…Surgery is indicated only in fulminant cases (3). The most frequent surgical solution is gut resection (7) or limited colectomy (50).…”