Pneumatosis intestinalis

Meyers, Morton A.; Ghahremani, Gary G.; Clements, James L.; Goodman, Ken

doi:10.1007/bf02256476

Cited by 84 publications

(21 citation statements)

References 44 publications

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“…Most concerningly, PI may be indicative of necrotic tissue allowing gas to penetrate the submucosa. Mesenteric ischemia from low-flow states or infarction from acute arterial occlusion may be the most concerning of the high risk etiologies and can give rise to this clinical picture [11]. A high index of suspicion warrants an urgent intervention and consideration of surgical consultation for suspected ischemia or infarction.…”

Section: Discussionmentioning

confidence: 99%

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Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

2019

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Pneumatosis intestinalis (PI) is a rare condition of the presence of gas within the bowel walls. PI is associated with numerous underlying diseases, ranging from life-threatening to innocuous conditions. PI is believed to be secondary to coexisting disorders in approximately 85% of all cases. This paper reviews the case of a patient who was diagnosed 7 years prior with pneumoperitoneum from unknown causes without any symptoms. The patient was admitted to the intensive care unit for the management of aspiration pneumonia and developed extensive PI after mechanical ventilation, presenting as small bowel obstruction with mesenteric torsion. Although the exact mechanism and etiology of PI are unclear, this case provides an update on the imaging features of and the clinical conditions associated with PI, as well as the management of this condition.

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Section: Discussionmentioning

confidence: 99%

“…Mechanical trauma such as recent surgical anastomosis and endoscopy can impair the normal mucosal barrier and may represent the underlying cause [11,13]. The differential also includes an abundance of infectious etiologies which can cause inflammation and thereby induce microbreaks in the mucosa.…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

2019

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“…Several theories have been proposed based on different observations, including (1) luminal gas penetrating the bowel mucosa into the bowel wall following mucosal injury, [3][4][5] (2) pulmonary gas released from the ruptured alveoli dissecting along vascular channels in mediastinum and tracking through the retroperitoneum into the mesenteric root, 6,7 (3) gas production of some bacteria that invades through the mucosal breaches into the intramural compartments and/or grows within the microscopic cysts, 8 and (4) gas production related to defects in food digestion causing excessive fermentation. 9 In addition, a suggestion that the cystic spaces in PCI are dilated lymphatic vessels has been lingering in literature.…”

mentioning

confidence: 99%

Is Pneumatosis Cystoides Intestinalis Gas-Distended and Ruptured Lymphatics?: Reappraisal by Immunohistochemistry

Gui

Zhou

Eidus

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Pneumatosis cystoides intestinalis (PCI) is a condition with multiple gas-filled cysts within the bowel wall, associated with diverse background diseases. Its pathogenesis is still a mystery. Some previous observations scattered in the literature have suggested an association of the cystic spaces in PCI with the lymphatics.Objective.-To further investigate whether PCI results from the ballooning of gas-filled lymphatic channels.Design.-We did immunostaining of podoplanin, a mucoprotein preferentially expressed in lymphatic endothelial cells, in 13 cases (8 men, 5 women; age range, 18-80 years) of PCI. Ten cases were diagnosed in resected segments of bowel and 3 in biopsies. Pneumatosis was seen in the right side of the colon (9 cases), transverse colon (1 case), sigmoid colon (1 case), and small bowel (2 cases). In addition, immunostaining for CD31, calretinin, WT1, CD68, smooth muscle actin, desmin, vimentin, and cytokeratins was also performed for comparison and correlation.Results.-A strong immunopositivity of podoplanin was seen in a condensed linear structure in the pericystic interstitium in 100% of the cases, but was not seen in the overlying giant and flat cells that were all CD68-positive histiocytes. Meanwhile, the podoplanin-expressing structure was negative for calretinin and WT1, which ruled out the possible mesothelial origin. There were coexistent variable immunopositivity of smooth muscle actin, which suggests an admixture of myofibroblasts. These findings indicated that the PCI cases were gas-distended lymphatics with the lymphatic epithelium ruptured and embedded in the reactive histiocytes and giant cells.Conclusion.-Our findings support the lymphatic theory about the pathogenesis of PCI.

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“…Evaluation with a lung window is a prerequisite for reliable diagnosis of pneumatosis with CT. The presence of gas in the mesenteric or portal venous system in mesenteric ischemia is indicative of an unfavorable prognosis.Key words: CT--Pneumatosis intestinalis--Pneumatosis cystoides intestinalis--Intestinal ischemia--Pneumoperitoneum.ium enema (for a detailed review, see [2]). CT, however, enables precise assessment of localization and extent of intramural gas accumulations.…”

mentioning

confidence: 99%

“…A wide range of pathologic conditions can be identified, which may lead to secondary pneumatosis (Table 1) [2]. All cases of pneumatosis intesfinalis are characterized by the presence of gas in the wall of the gastrointestinal tract, which may affect any part except the esophagus.…”

mentioning

confidence: 99%

Computed tomography in pneumatosis intestinalis: Differential diagnosis and therapeutic consequences

et al. 1995

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Case reports of five patients with pneumatosis intestinalis diagnosed by computed tomography (CT) are presented. Etiology, differential diagnoses, and clinical consequences arising from CT imaging are discussed. In four of the patients, pneumatosis was found to be secondary to gastric ulcer, colon carcinoma, metastasis in the mesentery, and trauma-induced mesenteric ischemia. In one patient, the etiology remained elusive. Using CT, both the extent and the distribution pattern of pneumatosis could be depicted, allowing for differentiation of primary and secondary forms and assessment of prognosis. Evaluation with a lung window is a pre-requisite for reliable diagnosis of pneumatosis with CT. The presence of gas in the mesenteric or portal venous system in mesenteric ischemia is indicative of an unfavorable prognosis.

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Pneumatosis intestinalis

Cited by 84 publications

References 44 publications

Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

Is Pneumatosis Cystoides Intestinalis Gas-Distended and Ruptured Lymphatics?: Reappraisal by Immunohistochemistry

Computed tomography in pneumatosis intestinalis: Differential diagnosis and therapeutic consequences

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