Pneumoperitoneum resulting from pneumatosis cystoides intestinalis: a rare complication of massive colonic dilatation

Ong, K.J.; Ng, Kheng-Hong; Lim, Kwanghui; Low, Su-Chong Albert; Eu, Kong‐Weng

doi:10.1007/s10151-009-0559-2

Cited by 3 publications

(1 citation statement)

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“…The mortality rates of PI are reported 65%-86% in previous studies when accompanied by portal venous gas (PVG) [11][12][13][14] . However, recently numerous non-ischemic causes of PI have been described because of the improved sensitivity in detection of PI by computed tomography (CT): non-ischemic causes of PI include inflammatory bowel disease, intestinal dilatation, connective tissue disease, organ transplantation or post-operative change, immune-deficiency status, and chemotherapy [15][16][17][18][19] . PI induced by these non-ischemic causes commonly show a benign clinical course and require conservative management rather than surgery.…”

Section: Introductionmentioning

confidence: 99%

Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

Hong

Hwang

et al. 2018

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

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Section: Introductionmentioning

confidence: 99%

Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

Hong

Hwang

et al. 2018

Rev. Assoc. Med. Bras.

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Improvement of pneumatosis cystoides intestinalis after steroid tapering in a patient with bronchial asthma: a case report

et al. 2013

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IntroductionWe report the case of a patient who was diagnosed as having pneumatosis cystoides intestinalis while being treated with prednisolone for bronchial asthma. Even before we had experienced a case of this, the relationship between pneumatosis cystoides intestinalis and prednisolone was unclear. In this case, pneumatosis cystoides intestinalis was improved with the reduction of prednisolone, and therefore we thought a direct relationship between pneumatosis cystoides intestinalis and prednisolone might become clear, such as whether it is dose dependent.Case presentationA 62-year-old Japanese woman had been treated for bronchial asthma for approximately 40 years. She presented with abdominal distension, and a radiographic examination showed intraperitoneal free gas and intramural gas, suggestive of pneumatosis cystoides intestinalis. However, when her prednisolone dose was decreased from 30mg to 0mg for approximately a year because of improvement in her asthma symptoms, her abdominal symptom resolved, and the frequency of her bowel movements returned to normal.ConclusionAmelioration of pneumatosis cystoides intestinalis was observed with tapering of the prednisolone, suggesting that prednisolone may have been involved in the pathogenesis of pneumatosis cystoides intestinalis in this patient.

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The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review

Perrone,

Giuffrida,

Donato

et al. 2024

JPM

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Purpose: Pneumatosis intestinalis is a radiological finding with incompletely understood pathogenesis. To date, there are no protocols to guide surgical intervention. Methods: A systematic review of literature, according to PRISMA criteria, was performed. Medline and PubMed were consulted to identify articles reporting on the items “emergency surgery, pneumatosis coli, and pneumatosis intestinalis” from January 2010 up to March 2022. This study has not been registered in relevant databases. Results: A total of 1673 patients were included. The average age was 67.1 ± 17.6 years. The etiology was unknown in 802 (47.9%) patients. Hemodynamic instability (246/1673–14.7% of the patients) was associated with bowel ischemia, necrosis, or perforation (p = 0.019). Conservative management was performed in 824 (49.2%) patients. Surgery was performed 619 (36.9%) times, especially in unstable patients with bowel ischemia signs, lactate levels greater than 2 mmol/L, and PVG (p = 0.0026). In 155 cases, surgery was performed without pathological findings. Conclusions: Many variables should be considered in the approach to patients with pneumatosis intestinalis. The challenge facing the surgeons is in truly identifying those who really would benefit and need surgical intervention. The watch and wait policy as a first step seems reasonable, reserving surgery only for patients who are unstable or with high suspicion of bowel ischemia, necrosis, or perforation.

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Pneumoperitoneum resulting from pneumatosis cystoides intestinalis: a rare complication of massive colonic dilatation

Cited by 3 publications

References 0 publications

Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

Improvement of pneumatosis cystoides intestinalis after steroid tapering in a patient with bronchial asthma: a case report

The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review

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