Pneumatosis cystoides intestinalis

Abstract

Rationale: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts in the intestinal wall, and can be caused by many conditions. Patient concerns: We reported a-69-year-old man with a long history of chronic obstructive pulmonary disease was admitted to the gastroenterology department because of alternating bowel movement and intermittent bloody stool. Diagnoses: Colonoscopy revealed multiple nodular protuberances covered with normal-looking mucosa in the ascending and proximal transverse colon. Abdominal computed tomography scan and endoscopic ultrasound revealed multiple gas-filled cystic lesions in the submucosa. The diagnosis of PCI was confirmed by cyst collapse after puncturing with a fine needle. Interventions and outcomes: Considering that the patient had no peritonitis or other complications, conservative approaches, including oxygen inhalation and oral probiotics, were used. The patient was transferred to the anorectal department after 5days of clinical observation in good condition to further treat hemorrhoids. Lessons: PCI is a rare condition that may be secondary to many other diseases. Because of its atypical clinical manifestations, it can be misdiagnosed as other diseases, such as polyps, inflammatory bowel disease, and even cancer. The diagnosis of PCI depends on computed tomography, colonoscopy, and endoscopic ultrasonography. Fine-needle aspiration may be helpful in the diagnosis and treatment of PCI.

Pneumatosis intestinalis as a manifestation of chronic intestinal volvulus: case report

“…5,9,10 Subacute presentations have been described in association with the following pathologies: chronic obstructive pulmonary disease, intraabdominal abscess, diverticular disease, intestinal obstruction, inflammatory bowel disease, acute gastric dilation, organ transplantation, barium enema, steroid use, volvulus, intestinal cancer, abdominal trauma, corrosive ingestion, haemodialysis, infection by parasites, bacteria or HIV, vasculitis, collagen diseases, and leukemia. 3,4,10 Primary or idiopathic intestinal pneumatosis: represents 15% of intestinal pneumatosis cases, and typically, patients do not present with underlying pathology. 2,5,9…”

“…6 Attention is focused on the underlying disease responsible, as the majority of cases of intestinal pneumatosis are asymptomatic and secondary to an underlying condition. 8,10 Remission has been reported in 70% of patients with non-surgical management. 5 Antibiotic therapy is recommended until clinical or radiological resolution of pneumatosis, with metronidazole being the most commonly used antibiotic, inhibiting bacterial growth and thereby preventing hydrogen production.…”