Pneumatosis intestinalis with a benign clinical course: a report of two cases

Abstract

BackgroundPneumatosis intestinalis (PI) is a rare condition characterized by the presence of gas within the gastrointestinal tract wall. Most cases of PI have a benign clinical course, although some have serious outcomes. Mechanical stress on or bacterial infection of the gastrointestinal tract wall may be responsible for the onset of PI, but the detailed mechanism of PI pathogenesis is still unclear. Here, we describe two Japanese patients presenting with benign PI.Case presentationCase 1, a 37-year-old previously healthy male patient, had a 1-week history of abdominal pain, and case 2, a 78-year-old female diabetic patient, had a 2-week history of voglibose treatment and abdominal pain. Intramural gas was mainly distributed in the colon in case 1 and in the small intestine in case 2. Interestingly, neither patient showed obvious inflammatory signs upon admission and recovered spontaneously with conservative treatment, including fasting and fluid infusion without antibiotics. Voglibose treatment was terminated in case 2. Recent studies have shown the presence of nonpathogenic bacteria, such as Clostridium spp., in PI lesions, which usually play an important role in modulating the tolerance of the gastrointestinal immune responses. The benign clinical course and spontaneous resolution of PI in these patients, without specific treatment, suggests that nonpathogenic indigenous bacteria in the gastrointestinal tract participate in the pathogenesis of PI.ConclusionIn patients with benign PI, the absence of an inflammatory response and the spontaneous resolution of the disease without specific treatment suggest the participation of nonpathogenic indigenous bacteria of the gastrointestinal tract.

Radiography and ultrasonography of pneumatosis intestinalis in a cat

“…In human literature, it has been stated that pneumatosis intestinalis is rarely fatal with the exception of bowel ischemia and other life‐threatening causes . Spontaneous resolution of benign pneumatosis intestinalis with nonspecific therapy has also been documented . Mortality rates for portal venous gas have been reported to range from 27–47%, while in one human study, the association of pneumatosis intestinalis and portal venous gas correlated to a 100% fatality rate …”

Pneumatosis intestinalis and porto-mesenteric venous gas: a multicenter study

“…Apart from these clearly life-threatening pathologies, benign/reversible causes like respiratory disorders and / or unfavourable drug related side effects—e.g. chemotherapy-associated—have been reported [ 10 – 12 ]. The Clinical presentation can be unspecific, but the most common symptoms involve abdominal pain, diarrhoea, bloody stools, fever, and shock [ 1 , 13 , 14 ].…”

“…Although PI and PMVG have been discussed for decades, there is little to no comprehensive evidence-based data on PI and especially PMVG. Most data available on benign and reversible causes of PVMG is based on case reports or case series [ 10 , 12 ].

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Pneumatosis Intestinalis and Porto-Mesenteric Venous Gas: A Multicentre Study

“…Apart from these clearly life-threatening pathologies, benign / reversible causes like respiratory disorders and / or unfavourable drug related side effects -e.g. chemotherapy-associated -have been reported (10)(11)(12). Clinical presentation can be unspeci c, but the most common symptoms involve abdominal pain, diarrhoea, bloody stools, fever, and shock (1,13,14).…”

“…Although PI and PMVG have been discussed for decades, there is little to no comprehensive evidence-based data on PI and especially PMVG. Most data available on benign and reversible causes of PVMG is based on case reports or case series (10,12).…”