Pneumatosis cystoides intestinalis associated with etoposide in hematological malignancies: a case report and a literature review

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of air collection within the subserosa and/or submucosa of the gastrointestinal wall. Due to the lack of specific symptoms, PCI is likely to be misdiagnosed or missed without the use of imaging techniques or gastrointestinal endoscopy. Here, we report a patient who complained of abdominal distention and constipation after chemotherapy for hematological malignancies, and was diagnosed with secondary PCI via computed tomography (CT) and exploratory laparotomy. Pneumoperitoneum was no longer observed after two weeks of conservative treatments. Notably, the possibility of intra-abdominal pressure (IAP) as a predictor for surgical intervention was proposed. Furthermore, we conducted a literature review on PCI after chemotherapy in hematological malignancies to raise awareness of etoposide-related PCI, while whether PCI could be identified as an adverse event of etoposide requires more evidence.

Pneumatosis intestinalis post steroid use in a patient with immune-related adverse events: Case report, literature review and FAERS analysis

“…PI without evidence of further intra-abdominal pathology does not necessitate laparotomy ( Galm et al, 2001 ). PI complicated by bowel obstruction or ischemia tends to require emergency surgical intervention, which correlates with a higher clinical severity score (including degrees of pain, fever, tenderness, diarrhea, blood per rectum , and hypotension) ( Yang et al, 2022 ). In our case, the absence of peritonitis, ischemia, and perforation, enabled conservative treatment with ceftriaxone, omeprazole, and sandostatin.…”

Northern State Medical University; Arkhangelsk Regional Children’s Clinical Hospital named after P. G. Vyzhletsov

“…КПК, в некоторых случаях, является вторичным на фоне механических травм желудочно-кишечного тракта, аутоиммунных заболеваний, кишечных инфекций, иммуносупрессивных состояний (во время и после химиотерапии злокачественных опухолей и трансплантации гемопоэтических стволовых клеток). Предполагается, что применение противоопухолевых и таргетных препаратов может быть значимой причиной желудочно-кишечной токсичности [5][6][7].…”

“…Препараты из группы цитостатиков, например винкристин, воздействуя на нервные окончания, могут вызывать динамическую кишечную непроходимость, что является предрасполагающим фактором для развития КПК. Данные группы препаратов применялись в терапии у наших пациентов и могли сыграть значительную роль в развитии КПК [5]. В литературе описана многоликая клиническая картина КПК [1], но в описанных нами случаях превалировали следующие симптомы: боли в животе, запор, вздутие живота.…”

Clinical and Endoscopic Features of Pneumatosis Cystoides Intestinalis: A Retrospective Study in 192 Patients

“…Lesions with colonic localizations are called colonic PCI, with predominant submucosa involvement. 2 Although it has been found PCI is in association with dysbacteriosis, inflammation, and physical injury of intestinal mucosa, the exact pathogenesis remains unknown. 3 Pneumatosis cystoides intestinalis is easy to be misdiagnosed or underdiagnosed and generally found in colonoscopy or radiological imaging by accidence due to lack of specific symptoms.…”