Incidental finding of esophageal pneumatosis

Abstract

Pneumatosis of the gastrointestinal tract is a rare condition characterized by the presence of air filled cavities in the gastrointestinal tract wall. Its occurrence has been described throughout the gastrointestinal tract from the esophagus to the rectum, however it is most commonly reported in the small intestine. Despite multiple case reports in literature, its pathogenesis still remains unclear. Pneumatosis may be idiopathic or associated with a variety of disorders namely peptic ulcer disease, jejunoileal bypass, intestinal obstruction and non-gastrointestinal disorders like asthma, chronic obstructive pulmonary disease, systemic lupus erythematosus, infectious enteritis, etc. We here present a rare case of pneumatosis of the esophagus diagnosed incidentally at an esophagogastroduodenoscopy (EGD). A 78-year-old asymptomatic woman underwent EGD and colonoscopy at our hospital for evaluation of anemia. Few months prior to EGD, she had undergone excision of laryngocele at our hospital. EGD revealed extensive submucosal blebs distributed throughout the esophagus, otherwise unremarkable stomach and duodenum. Colonoscopy showed a tubular adenomatous polyp. Since our patient was asymptomatic she did not require any surgical intervention. Management of pneumatosis depends on the underlying cause.

An Extremely Rare Cause of Dysphagia

“…1 Esophageal pneumatosis is extremely rare, with only 9 cases reported in the literature. 2 In contrast with our patient, who presented with dysphagia, most cases of esophageal pneumatosis are incidental findings in asymptomatic patients. The diagnosis is usually made by endoscopy and imaging modalities, particularly CT scan as the most sensitive diagnostic test.…”

“…The diagnosis is usually made by endoscopy and imaging modalities, particularly CT scan as the most sensitive diagnostic test. 2 As demonstrated in this case, the classic endoscopic appearance is the presence of air bubbles in the esophageal submucosa, which collapse with insufflation. The characteristic features on the CT scan are circumferential intramural collections of air.…”

Esophageal pneumatosis in the setting of small bowel ileus with acute resolution after nasogastric tube decompression

“…In light of patient's CT diagnosis of ileus, we hypothesize that our patient developed esophageal pneumatosis secondary to mechanical rather than bacterial causes. According to mechanical theory, air present in the gastrointestinal tract lumen dissects into the walls of the gastrointestinal tract through a mucosal tear [1] , [5] . However, as in our case, even if a mechanical cause is suspected, ischemia of the intestine should be ruled out [2] , [6] , [7] .…”

“…Esophageal pneumatosis is a rare condition with diverse potential etiologies including traumatic, mechanical, ischemic, obstructive respiratory, autoimmune, immune deficient, chemotherapy side effect, and infectious causes [1] , [2] , [3] , [4] , [5] . Here, we present a case of esophageal pneumatosis in the setting of upper gastrointestinal and small bowel ileus, diagnosed on computed tomography (CT) with subsequent acute resolution after nasogastric tube decompression, confirmed on interval CT just 11 hours after the initial diagnosis.…”

Esophagogastroduodenal pneumatosis with subsequent pneumoporta and intramural duodenal hematoma after endoscopic hemostasis: a case report

“…Depending on the involved site of gastrointestinal tract, clinical presentation of PI is usually nonspecific, varying from chest pain, diarrhea, constipation, abdominal pain, abdominal distension, nausea, vomiting, to gastrointestinal bleeding, or even no symptom [ 1 , 3 , 4 ].…”