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Pneumatosis intestinalis a trap for the unwary: Case series and literature review

INTRODUCTION: Pneumatosis Intestinalis (PI) can present with a broad range of presentations from chronic and non-specific to acute and life threatening. It is paradoxically one of the few conditions where a pneumoperitoneum found in the diagnostic workup is not necessarily an indication for laparoto...

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Autores principales: Dhadlie, Sunny, Mehanna, Daniel, McCourtney, James
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232619/
https://www.ncbi.nlm.nih.gov/pubmed/30428434
http://dx.doi.org/10.1016/j.ijscr.2018.10.079
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author Dhadlie, Sunny
Mehanna, Daniel
McCourtney, James
author_facet Dhadlie, Sunny
Mehanna, Daniel
McCourtney, James
author_sort Dhadlie, Sunny
collection PubMed
description INTRODUCTION: Pneumatosis Intestinalis (PI) can present with a broad range of presentations from chronic and non-specific to acute and life threatening. It is paradoxically one of the few conditions where a pneumoperitoneum found in the diagnostic workup is not necessarily an indication for laparotomy. PRESENTATION OF CASES: The first case is of a 75 year old gentlemen who attended the emergency department after several weeks of worsening abdominal pain and weight loss. At laparotomy, two segments of nodular, abnormal-looking small bowel were identified with bubbles of air seen in the small bowel mesentery. The second case is of an 86 year old man with of a 5-month history of abdominal pain, weight loss, nausea and diarrhoea. A subsequent endoscopy revealed diffuse gastritis with a small antral gastric ulcer with a small amount of blood. The CT scan demonstrated free air within the bowel wall, with a follow up scan performed 3 weeks later revealing an increase in the amount of free air. DISCUSSION: PI is a rare condition characterised by the presence of subserosal and submucosal gas filled cysts occurring anywhere in the gastrointestinal tract from the oesophagus to the anus. Numerous conditions have been associated with PI including bowel obstruction, infections, ischemia and there have been reported cases suggesting as association with Crohn’s disease. CONCLUSION: PI is a condition that may manifest with a wide range of symptoms from mild abdominal pain to acute peritonitis. Its treatment is generally medical and even with radiological evidence of perforation laparotomy may not be indicated if the patient is clinically well.
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spelling pubmed-62326192018-11-29 Pneumatosis intestinalis a trap for the unwary: Case series and literature review Dhadlie, Sunny Mehanna, Daniel McCourtney, James Int J Surg Case Rep Article INTRODUCTION: Pneumatosis Intestinalis (PI) can present with a broad range of presentations from chronic and non-specific to acute and life threatening. It is paradoxically one of the few conditions where a pneumoperitoneum found in the diagnostic workup is not necessarily an indication for laparotomy. PRESENTATION OF CASES: The first case is of a 75 year old gentlemen who attended the emergency department after several weeks of worsening abdominal pain and weight loss. At laparotomy, two segments of nodular, abnormal-looking small bowel were identified with bubbles of air seen in the small bowel mesentery. The second case is of an 86 year old man with of a 5-month history of abdominal pain, weight loss, nausea and diarrhoea. A subsequent endoscopy revealed diffuse gastritis with a small antral gastric ulcer with a small amount of blood. The CT scan demonstrated free air within the bowel wall, with a follow up scan performed 3 weeks later revealing an increase in the amount of free air. DISCUSSION: PI is a rare condition characterised by the presence of subserosal and submucosal gas filled cysts occurring anywhere in the gastrointestinal tract from the oesophagus to the anus. Numerous conditions have been associated with PI including bowel obstruction, infections, ischemia and there have been reported cases suggesting as association with Crohn’s disease. CONCLUSION: PI is a condition that may manifest with a wide range of symptoms from mild abdominal pain to acute peritonitis. Its treatment is generally medical and even with radiological evidence of perforation laparotomy may not be indicated if the patient is clinically well. Elsevier 2018-11-02 /pmc/articles/PMC6232619/ /pubmed/30428434 http://dx.doi.org/10.1016/j.ijscr.2018.10.079 Text en © 2018 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dhadlie, Sunny
Mehanna, Daniel
McCourtney, James
Pneumatosis intestinalis a trap for the unwary: Case series and literature review
title Pneumatosis intestinalis a trap for the unwary: Case series and literature review
title_full Pneumatosis intestinalis a trap for the unwary: Case series and literature review
title_fullStr Pneumatosis intestinalis a trap for the unwary: Case series and literature review
title_full_unstemmed Pneumatosis intestinalis a trap for the unwary: Case series and literature review
title_short Pneumatosis intestinalis a trap for the unwary: Case series and literature review
title_sort pneumatosis intestinalis a trap for the unwary: case series and literature review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232619/
https://www.ncbi.nlm.nih.gov/pubmed/30428434
http://dx.doi.org/10.1016/j.ijscr.2018.10.079
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