Welche Bedeutung hat die Diagnose „Pneumatosis intestinalis“ und „Portal Gas“ für den Chirurgen?

Abstract

Pneumatosis intestinalis (PI) describes the existence of gas in the wall of the gastrointestinal tract; portal gas (PG) describes gas in the portovenous system. Both are predominantly diagnosed radiologically (computed tomography as the most sensitive method) and do not represent per se self-contained syndromes, but PI and PG are possible symptoms of a variety of diseases. Possible sources of gas are bacterial gas (e. g., bowel wall invasion by aerogenic bacteria), intraluminal and extraluminal enteric gas (e. g., increased intraluminal pressure e.g. endoscopy), and pulmonary gas (e. g., COPD). The treatment of PI /PG depends on the underlying disease. The decision for laparotomy/ laparoscopy should be a conclusion of clinical and possibly radiological signs. Since in many cases, the simultaneous detection of PI and PG, is caused by mesenterial ischemia and has a poor prognosis, in these cases, the decision for operation (laparotomy/ laparoscopy) should be made liberally. A symptomatic therapy with metronidazole and oxygen should be considered, if despite the adequate treatment of the underlying disease, PI continues with abdominal symptoms (such as intestinal pseudo-obstruction or nonspecific abdominal pain).

Bezoar as a cause of portal vein pneumatosis: a case report

“…It is not an independent disease but is usually accompanied by digestive tract diseases such as intestinal obstructive disease, mesenteric vascular disease, 4 gastric ulcers 5,6 gastric cancer, 7 peptic ulcers, 4 endoscopic and radiation surgery. 8–13 Previous reports have indicated that HPVG is often associated with severe intestinal diseases and has a mortality rate of up to 75%. 4 It is also often considered an indication for emergency abdominal surgery and has been termed the “sign of death.” As a result of the enormous progress and development in the field of medicine, Kinoshita et al.…”

Pneumatosis intestinalis with portal, mesenteric and renal gas due to colonic pseudo-obstruction

“…In association with portomesenteric venous gas, pneumatosis intestinalis is often a radiological sign of bowel ischemia and is associated with a high mortality rate of up to 75% [ 2 ]. However, overall, these signs do not point to specific diagnoses but are general symptoms or radiological signs, which have several medical etiologies [ 3 ].…”