Presentation
The presenting clinical picture may be very heterogeneous and represent a challenge for the clinician. In the present paper we describe both a common and an uncommon clinical presentation of PCI and review the pertaining literature. [ncbi.nlm.nih.gov]
[…] have contributed to this patient's presentation with PCI. [consultant360.com]
At 48 h the patient presented with important clinical improvement and with normal-range laboratory results. [revistagastroenterologiamexico.org]
Entire Body System
- Relapsing Polychondritis
Relapsing polychondritis (RP) is a rare systemic disease characterized by an inflammatory process involving predominantly cartilaginous structures. Pneumatosis cystoides intestinalis (PCI) in RP has not been reported previously. [ncbi.nlm.nih.gov]
- Camping
Department of Radiology, Marienhospital Herne, Ruhr-University Bochum, Bochum, Hölkeskampring 40, 44625 Herne, Germany (3) Department of Pathology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University Bochum, Bürkle de la Camp-Platz [jmedicalcasereports.biomedcentral.com]
Respiratoric
- Respiratory Disorders
They usually have a history of chronic respiratory disorders like bronchitis and asthma, malabsorption syndrome, connective tissue disorders or intake of substrates which remain unabsorbed inside the gut like lactulose or sorbitol [ 1 ]. [transbiomedicine.com]
Gastrointestinal
- Abdominal Tenderness
On examination, the patient was lethargic but did not have abdominal tenderness. Given her CT scan findings and a concern for sepsis, an urgent diagnostic laparoscopy was conducted. [ommegaonline.org]
Physical examination at admission revealed pronounced abdominal tenderness and abdominal mass. [bmcgastroenterol.biomedcentral.com]
As a result of these findings, steroid therapy was renewed shortly before PCI was detected, due to a rapid deterioration in the patient's general condition in conjunction with distinct abdominal tenderness. [nature.com]
- Upper Abdominal Pain
Case Report A 29-year-old man who complained of abdominal pain for several days visited our hospital in June 2014. A physical examination revealed tenderness in the right upper abdomen. [karger.com]
Neurologic
- Encephalopathy
Pneumatosis Cystoides Intestinalis with Hepatic Cirrhosis and leptopirosis A 42-year-old male, admitted to the hospital due to hepatic encephalopathy due to alcoholic cirrhosis of the liver. [gastrointestinalatlas.com]
Workup
X-Ray
- Pneumoperitoneum
PCI with pneumoperitoneum induced by α-glucosidase inhibitor is rare, with only 27 cases (excluding the present case) reported in Japan to date. [ncbi.nlm.nih.gov]
The latter is a sign of pneumoperitoneum. (B) An upright view revealed an air-fluid level and pockets of free air under the diaphragm (arrows). [amjmed.org]
[…] cysts, but when these cysts rupture they may produce pneumoperitoneum and hence complicate the clinical scenario. [transbiomedicine.com]
Y.J....Zhang J. 2018 4 Stenotic Ischemic Enteritis with Concomitant Hepatic Portal Venous Gas and Pneumatosis Cystoides Intestinalis: A Case Report. ( 29491303 ) Iwai N....Itoh Y. 2018 5 Surgical treatment of pneumatosis cystoides intestinalis with pneumoperitoneum [malacards.org]
[…] colon or small bowel may also present with pneumoperitoneum. [ijcasereportsandimages.com]
Ultrasound
- Ovarian Mass
CT showed massive hydrops of abdominal cavity, multiple intraluminal gas pockets in the rectum and ovarian mass (Fig. 2g ), which was limited to the ovarian surface without invasion. [bmcgastroenterol.biomedcentral.com]
Serum
- Cytopenia
The biochemical tests revealed cytopenia due to AA and no obvious abnormality in stool culture for pathogens. Blood cultures were also negative. Computer tomography (CT) examination showed no portal venous gas embolism (Fig. 2c ). [bmcgastroenterol.biomedcentral.com]
QT, RR, ST Intervals
- ST Elevation
Investigations showed a non-ST elevation myocardial infarction with pulmonary edema. He was first managed conservatively and later taken up for emergency coronary artery bypass grafting. [njssjournal.org]
Other ECG Findings
- Ischemic Changes
However, neither ischemic change in the colonic wall nor ascites could be seen in the CT scan. Then, we performed an enema with gastrographin. [karger.com]
Treatment
The patient started prednisone treatment, but one month later treatment with voglibose, an alpha-glucosidase inhibitor (alpha-GI), was started because of prednisone-induced diabetes mellitus. [ncbi.nlm.nih.gov]
Normobaric oxygen treatment lasting six to ten days, has the advantage of being noninvasive, but does expose the patient to pulmonary oxygen toxicity. Recurrence following treatment is positive. [medigoo.com]
Prognosis
Pneumatosis cystoides intestinalis and hepatic portal venous gas suggests the presence of severe bowel ischemia associated with a very poor prognosis. An appropriate treatment should be performed immediately. top of page [minervamedica.it]
[…] mimic the appearance of pneumatosis on conventional radiographs CT will show air in bowel wall on dependent surface in pneumatosis Air in the lumen should rise to the highest non-dependent part of lumen Treatment None is usually needed for primary form Prognosis [learningradiology.com]
There are 6 cases of PCI with varied causes encountered, in which the etiology, endoscopic features, treatment methods and prognosis of patients were studied. [ncbi.nlm.nih.gov]
Two features of PCI have been described in the literature—cystic circumferential gas is associated with good prognosis, and linear gas is associated with poor prognosis [ 2, 11 ]. [surgicalcasereports.springeropen.com]
PI preceded by bowel ischemia or graft versus host disease colitis has the worst prognosis, and the presence of portal venous gas and acidosis correlate with poor outcome. Not all patients with pneumoperitoneum require surgical intervention. [pediatrics.aappublications.org]
Etiology
There are 6 cases of PCI with varied causes encountered, in which the etiology, endoscopic features, treatment methods and prognosis of patients were studied. [ncbi.nlm.nih.gov]
General Benign, generally asymptomatic subset of pneumatosis intestinalis. [1] Small or large bowel. [2] Possible etiologies: [3] IBD. Infection. Bowel necrosis. Malignancy. Drugs, e.g. alpha-glucosidase inhibitors. Idiopathic. [librepathology.org]
Further studies are justified for every aspect of PCI from epidemiology, etiology, presentations, diagnosis, and treatments to prognosis. [surgicalcasereports.springeropen.com]
Epidemiology
Scleroderma epidemiology. (2003) Rheum Dis Clin North Am 29(2): 239-254. 2. Gompels, B.M. Pneumatosis cystoides intestinalis associated with progressive systemic sclerosis. (1969) Br J Radiol 42(501): 701-703 3. [ommegaonline.org]
Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2013; 75 (1): 15-23[ DOI ][ PubMed ] 2. Galandiuk S, Fazio VW. [colorectalresearch.com]
Patients with Systemic Sclerosis: A Case Report and Review of 39 Japanese Cases. ( 27651961 ) Kaneko M....Watanabe T. 2016 28 A Case of Intussusception Associated with Pneumatosis Cystoides Intestinalis. ( 27721738 ) Fujiya T....Tadokoro K. 2016 29 Epidemiological [malacards.org]
They also found no studies on epidemiology or randomised control trials on PCI. [surgicalcasereports.springeropen.com]
Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev. 2002;15(1):145-154. 19. Marigold JH. Pneumatosis cystoides coli and chloral hydrate. Gut. 1998;42(6):899-900. 20. Florin TH. [consultant360.com]
Pathophysiology
The pathophysiology is incompletely understood. [nejm.org]
The pathophysiology is incompletely understood and is probably multifactorial in nature. PCI is a known but rare complication of systemic scleroderma, and the aetiology of PCI in patients with scleroderma is not fully understood. [ncbi.nlm.nih.gov]
Discussion Although more than a century has passed since the original description by Bang 12 of PCI in a human setting the underlying pathophysiology remains unclear. [nature.com]
Improving knowledge of the natural history, pathophysiology and prognostic factors of SSc among the various specialties involved may help with treatment decisions. [ommegaonline.org]
Prevention
Prevention of bacterial endocarditis. [books.google.com]
Surgery neither resolves PCI secondary to SSc nor does it prevent its recurrence. Several lessons emerge from these two cases. SSc in older adults is rare, but may be more severe and progressive when present. [ommegaonline.org]
It is likely that cysts prevented any increase of intrarectal pressure, particularly which followed the arrival of stools into the rectal ampulla. [em-consulte.com]
Contrast Enhanced Computerised Tomography (CECT) scan of the abdomen is a better modality for diagnosing Pneumatosis cystoides intestinalis (PCI) and it can prevent unnecessary surgeries. [transbiomedicine.com]