Distinguishing Benign and Life-Threatening Pneumatosis Intestinalis in Patients With Cancer by CT Imaging Features

Lee, Kyungmouk Steve; Hwang, Sinchun; Rúa, Sandra M. Hurtado; Janjigian, Yelena Y.; Gollub, Marc J.

doi:10.2214/ajr.12.8942

Cited by 81 publications

(86 citation statements)

References 14 publications

(36 reference statements)

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“…Clinical course of PI varies: most PI patients without surgical acute abdomen will improve with supportive therapy, encompassing bowel rest and antibiotics. The presence of certain CT features (mesenteric stranding, bowel wall thickening, and ascites) and the location of PI may help distinguishing more significant bowel disease and more severe cases [16]. Unfortunately, PI can be a life-threatening complication leading to bacterial peritonitis or severe sepsis in ~20% of patients with PI regardless of its aetiology [4].…”

Section: Discussionmentioning

confidence: 99%

Is pneumatosis intestinalis a contraindication to allogeneic hemopoietic stem cell transplantation?

Ferretti¹,

Perrone²,

Torelli³

et al. 2016

Trends in Transplant

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Pneumatosis intestinalis (PI) has been described as a possible complication after allogeneic stem cell transplantation (HSCT) due to graft-versus-host disease (GVHD) or infections. So far, no patient with a pre-existent PI who underwent HSCT has been reported. We describe the case of a patient with Alk-negative anaplastic large B-cell lymphoma (DLBCL anaplastic) and PI who successfully received a HSCT from an unrelated donor without complications. This case suggests that this gastrointestinal condition should not be considered an absolute contraindication for an allotransplant procedure.

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Section: Discussionmentioning

confidence: 99%

Is pneumatosis intestinalis a contraindication to allogeneic hemopoietic stem cell transplantation?

Ferretti¹,

Perrone²,

Torelli³

et al. 2016

Trends in Transplant

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“…There are two popular postulated mechanisms of benign PI: mechanical and bacterial. The mechanical theory posits increased positive pressure and consequent leakage of air through microscopic breaks in the bowel wall 1 2 11 13. The bacterial theory puts forth translocation of gas-producing bacteria among the normal gut flora into the bowel wall and gas production within the mucosal layers 2 11…”

Section: Discussionmentioning

confidence: 99%

Benign pneumatosis intestinalis after bilateral lung transplantation

et al. 2015

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This series details two cases of benign pneumatosis intestinalis (PI) in patients post-lung transplant, which were discovered incidentally on routine surveillance chest radiographs during ambulatory clinic visits. Both patients had uneventful post-transplant recovery and were asymptomatic at presentation. The patients were admitted for observation. Contrast-enhanced abdominal CT scans confirmed the plain film findings. Both cases were managed conservatively with bowel rest, intravenous hydration and serial abdominal examinations. The patients had unremarkable hospital courses and were both discharged in good condition. Our current understanding of benign PI in patients post-transplant is limited to a few case series and case reports. Greater awareness of this entity may decrease unnecessary invasive procedures and improve management of these patients.

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“…Some experts have postulated that chronic corticosteroid use can cause atrophy of gastrointestinal lymphoid tissue, resulting in decreased submucosal integrity that may make it easier for intraluminal air to dissect into the intestinal wall (7). Patients with benign PI lack worrisome CT findings, such as bowel wall thickening or dilatation, ascites, soft-tissue stranding, free peritoneal fluid, small bowel involvement, or portal venous gas (8,9). The pattern of pneumatosis can also help distinguish benign from clinically worrisome PI.…”

Section: Discussionmentioning

confidence: 99%