Endoscopy Induced Gastric Pneumatosis

Bilreiro, Carlos; Brito, Jorge

doi:10.20344/amp.7403

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…The pathogenesis of secondary PI has been well demonstrated to be multifactorial, as follows: mechanical theory (mucosal disruption mainly by increased pressure within the intestinal lumen, and/or ischaemia), bacterial theory (infiltration of gas-forming bacilli into the submucosa) and pulmonary theory (disruption of alveoli followed by extension of gas through the mediastinum and perivascular spaces into the bowel wall). [4][5][6][7] Based on advanced imaging techniques and accumulation of cases with a wide spectrum of conditions, including iatrogenic PI and PI that is not related to abdominal pathology, [8][9][10][11] specific causes for PI have been more meticulously evaluated, but mostly as case series, to date. As such, it would be meaningful to revisit the current incidence of primary PI and the frequency of each specific cause in secondary PI.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of patients with pneumatosis intestinalis

Fujii

Yamashita

Tashiro

et al. 2021

ANZ Journal of Surgery

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Background: Several theories explaining the development of pneumatosis intestinalis (PI) have been reported, but a substantial portion of cases have been idiopathic. Additionally, predictors of bowel ischaemia in PI have not been fully investigated, while PI with bowel ischaemia has deteriorated overall outcomes of PI. Methods: Sixty-four patients diagnosed with PI (2009-2019) were allocated to two groups: with (group 1; n = 15 (23%)) and without (group 2; n = 49 (77%)) bowel ischaemia. Fourteen patients underwent emergency surgery, and bowel ischaemia was identified in nine (64%). Six patients in group 1 were diagnosed with bowel ischaemia, and were treated palliatively. On medical charts, we determined underlying conditions of PI, compared the characteristics and outcomes between the groups, and identified the predictors of bowel ischaemia. Results: Group 1 patients more commonly showed abdominal pain, lower base excess, higher C-reactive protein concentrations, higher white blood cell counts and higher neutrophil-to-lymphocyte ratios, and more frequent comorbid ascites, free air and hepatic portal vein gas. Of nine bowel ischaemia surgery patients, three (33%) died; all because of anastomotic leak. All except three patients in group 2, who presented with aspiration pneumonia, responded to treatment. Only one patient had an unknown cause (1/64, 1.6%), and various underlying conditions in secondary PI were confirmed. Conclusion: Idiopathic PI may be identified rarely using current imaging and knowledge, but outcomes in PI patients with bowel ischaemia remain unsatisfactory. Earlier identification of bowel ischaemia by various specialists in accordance with predictors of bowel ischaemia could improve overall outcomes in PI patients.

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Section: Introductionmentioning

confidence: 99%

Clinical characteristics of patients with pneumatosis intestinalis

Fujii

Yamashita

Tashiro

et al. 2021

ANZ Journal of Surgery

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The spectrum of pneumatosis intestinalis in the adult. A surgical dilemma

Tropeano¹,

Grezia²,

Puccioni³

et al. 2023

World J Gastrointest Surg

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Pneumatosis intestinalis (PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic significance nowadays has to be cross-referenced to the nature of the underlying condition. Multiple mechanisms of pathogenesis have been debated and multiple causes have been detected during the years. All this contributes to creating a broad range of clinical and radiological presentations. The management of patients presenting PI is related to the determining cause if it is identified. Otherwise, in particular if an association with portal venous gas and/or pneumoperitoneum is present, the eventual decision between surgery and non-operative management is challenging, even for stable patients, since this clinical condition is traditionally associated to intestinal ischemia and consequently to pending clinical collapse if not treated. Considering the wide variety of origin and outcomes, PI still remains for surgeons a demanding clinical entity. The manuscript is an updated narrative review and gives some suggestions that may help make the decisional process easier, identifying patients who can benefit from surgical intervention and those who can benefit from non-operative management avoiding unnecessary procedures.

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Endoscopy Induced Gastric Pneumatosis

Abstract: N/A.

Cited by 2 publications

References 4 publications

Clinical characteristics of patients with pneumatosis intestinalis

Clinical characteristics of patients with pneumatosis intestinalis

The spectrum of pneumatosis intestinalis in the adult. A surgical dilemma

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