Does Pneumatosis Intestinalis after Etoposide Chemotherapy always have a Benign Course?

Abstract

Pneumatosis intestinalis (PI) is the presence of gas within the wall of the intestine. It was first defined in 1783 by Du Vernoi (1). It is a critical condition and is a clinical sign rather than a disease. PI is difficult to diagnose because most patients are asymptomatic. This can be because of acute mesenteric ischemia (AMI) and subsequent bowel infarctions (2). The mortality rate of AMI is very high (3). PI is a rarely associated with the immunosuppressive status of a patient. Multidetector computed tomography (CT) is an important tool for assessing patients in the emergency room (ER). CT can provide important information regarding the cause of abdominal pain and site of ischemia if present. Conservative treatment with fasting and antibiotics can be considered in mild cases (4). However, the situation sometimes requires surgery and can be life threatening. 5) demonstrated that the most common causes of PI are vascular ischemia of mesentery, intestinal obstruction, and chemotherapy. The chemotherapeutics that have been reported with PI are methotrexate, daunorubicin, cytarabine, fluorouracil, paclitaxel, docetaxel, and intravenous etoposide (6). PI due to etoposide chemotherapy are mostly benign (6,7). However, in our case, we aim to show a patient who had etoposide chemotherapy because of testis neoplasm and was admitted to the hospital with abdominal pain but died because of AMI. Lee et al (

Pneumatosis Intestinalis Induced by Anticancer Treatment: A Systematic Review

“…All titles were screened, after which 65 full-text articles were assessed for eligibility. Ultimately, 50 records that met our eligibility criteria were identified, and 12 more reports were retrieved through reference mining, reaching a total of 62 articles that were included in our systematic review ( Figure 2 ) [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 62 , 64 , 65 , 67 , 68 , 69 , ...…”

“…Among adult patients, secondary PI is mainly associated with gastrointestinal disease, pulmonary diseases, mechanical ventilation, endoscopic procedures, infections and other immunological conditions [ 8 ]. Medications used for cancer treatment are among the most recognized causes of PI, including cytotoxic chemotherapeutic agents [ 9 ] and molecular targeted agents [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”