Pneumatosis Intestinalis and Pneumoperitoneum After Bilateral Lung Transplantation in Adults

Thompson, William M.; Ho, Lisa M.; Marroquin, Carlos E.

doi:10.2214/ajr.10.4468

Cited by 22 publications

(40 citation statements)

References 17 publications

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“…Although there have been rare case reports of PI developing in patients after thoracic organ transplant, 2,5 there is only one series published, which consisted of 7 patients presenting with pneumoperitoneum or PI after lung transplant. 13 The clinical presentation, radiographic appearance, and outcomes of previous case reports were quite similar to those for our 10 patients with PI. To our knowledge, this is the largest case series (consisting of 10 patients) of patients presenting with PI after lung transplant.…”

Section: Discussionsupporting

confidence: 84%

“…This agrees with an earlier case series in which all cases were noted to involve the large bowel. 13 We found that 50% of our patients had PI associated with air under the diaphragm (pneumoperitoneum). Presence of pneumoperitoneum with PI was not associated with poor outcomes (1 death was due to late lung infection), and only 1 patient required surgical exploration with documented bowel ischemia.…”

Section: Discussionmentioning

confidence: 59%

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Chandola

Laing²,

Lien³

et al. 2018

Exp Clin Transplant

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Objectives: We evaluated the incidence, clinical presentation, laboratory findings, possible causes, and outcomes associated with pneumatosis intestinalis in the setting of lung transplant. Materials and Methods: A departmental database showed that, between October 2002 and August 2013, our institution performed 373 lung transplants. The database was queried for all patients who had pneumatosis intestinalis and/or pneumoperitoneum after lung transplant at our institution. For this retrospective chart review, information collected included demographics, baseline variables, symptoms, signs, laboratory parameters, radiologic work-up, medications, including immunosuppressants at presentation, progress and time to resolution, length of hospital stay, and postoperative complications, as well as short-term and midterm outcomes (up to 1 year). Results: The incidence of pneumatosis intestinalis was 2.68% (10/373 patients). Mean age of patients was 52.2 years (range, 34.9-67.9 y). Mean time for development of pneumatosis intestinalis after transplant was 352.8 days (range, 5-2495 d). Abdominal symptoms and signs were present in 6 patients (60%). The large bowel was the site of involvement in all but 1 patient, with predilection for ascending colon (80%) and transverse colon (90%) in most patients. High serum lactate levels were found in 2 patients, and both underwent bowel resection, with surgical specimens revealing evidence of ischemic changes in the gut. Mean dose of prednisone was 22 mg at the time of presentation (range, 0-60 mg). Mean hospital length of stay was 16.9 days (range, 0-40 d). Short-term survival was 100%. Midterm survival at the end of 1 year was 80%. Mean time for pneumatosis to resolve was 18 days (range, 14-35 d). Conclusions: Pneumatosis intestinalis in bilateral lung transplant recipients can be treated with a minimal amount of imaging, and most patients can be treated conservatively. Survival outcomes are quite good, with 100% during the short term and 80% at 1 year in our series. Key words: Bowel resection, Pneumoperitoneum, Retrospective study, Survival IntroductionPneumatosis intestinalis (PI) is a bowel pathology defined as accumulation of gas in the submucosa or subserosa of the large or small intestine (Figure 1). It is seen in association with a number of diseases, but its pathogenesis is still obscure. It has shown an association with solid-organ and bone marrow transplant, 1-5 immunosuppressive drugs, especially steroids, 1,6,7

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 59%

Untitled

Chandola

Laing²,

Lien³

et al. 2018

Exp Clin Transplant

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“…1,7,8 In lung transplant patients, there have been several reports on pneumatosis intestinalis and pneumoperitoneum without evidence of an organ perforation. 2,4,6 As for the cause, Khalil and others have proposed different theories. 1,5 Increased intraintestinal or intramediastinal pressure due to either bowel or pulmonary obstruction can be responsible for dissection of gas into the bowel wall in the scope of a "mechanical theory."…”

Section: Discussionmentioning

confidence: 99%

“…In addition to medication-induced pneumatosis, systemic diseases (eg, lupus or acquired immunodeficiency syndrome), inflammatory bowel diseases, and pulmonary diseases (eg, asthma or cystic fibrosis), as well as bone marrow transplant, abdominal, and thoracic organ transplant, can lead to pneumatosis intestinalis. [1][2][3][4][5][6][7] In this case report, we present a patient with recurrent pneumoperitoneum and pneumatosis intestinalis after bilateral lung transplant in which we used a conservative approach involving antibiotic therapy with metronidazole.…”

Section: Introductionmentioning

confidence: 99%

A Case of Recurrent Pneumoperitoneum and Pneumatosis Intestinalis After Bilateral Lung Transplant

Beetz

Kleine²,

Vondran³

et al. 2019

Exp Clin Transplant

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We report a case of a 60-year-old male patient with recurrent episodes of free gas in the peritoneal and the retroperitoneal cavities as well as pneumatosis intestinalis 3 months after bilateral lung transplant. Interestingly, despite staged laparotomy within the scope of the first episode, no cause for free gas could be found. In a second episode of symptomatically pneumatosis, a conservative treatment with metronidazole was performed successfully. Despite several case reports on patients with pneumatosis intestinalis after lung transplant, an effective treatment strategy has not yet been proposed.

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“…There are two popular postulated mechanisms of benign PI: mechanical and bacterial. The mechanical theory posits increased positive pressure and consequent leakage of air through microscopic breaks in the bowel wall 1 2 11 13. The bacterial theory puts forth translocation of gas-producing bacteria among the normal gut flora into the bowel wall and gas production within the mucosal layers 2 11…”

Section: Discussionmentioning

confidence: 99%

Benign pneumatosis intestinalis after bilateral lung transplantation

et al. 2015

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This series details two cases of benign pneumatosis intestinalis (PI) in patients post-lung transplant, which were discovered incidentally on routine surveillance chest radiographs during ambulatory clinic visits. Both patients had uneventful post-transplant recovery and were asymptomatic at presentation. The patients were admitted for observation. Contrast-enhanced abdominal CT scans confirmed the plain film findings. Both cases were managed conservatively with bowel rest, intravenous hydration and serial abdominal examinations. The patients had unremarkable hospital courses and were both discharged in good condition. Our current understanding of benign PI in patients post-transplant is limited to a few case series and case reports. Greater awareness of this entity may decrease unnecessary invasive procedures and improve management of these patients.

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Pneumatosis Intestinalis and Pneumoperitoneum After Bilateral Lung Transplantation in Adults

Cited by 22 publications

References 17 publications

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A Case of Recurrent Pneumoperitoneum and Pneumatosis Intestinalis After Bilateral Lung Transplant

Benign pneumatosis intestinalis after bilateral lung transplantation

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