Pneumatosis Intestinalis in Adults: Management, Surgical Indications, and Risk Factors for Mortality

Greenstein, Alexander J.; Nguyen, Scott Q.; Berlin, Ana; Corona, Jacqueline; Lee, Jonathan; Wong, Everlyn; Factor, Stephanie H.; Divino, Celia M.

doi:10.1007/s11605-007-0241-9

Cited by 136 publications

(175 citation statements)

References 15 publications

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“…Endoscopy can be used to confirm air in the lamina propria of the tissue, as well as to rule out the non-gangrenous causes of pneumatosis. According to Greenstein [16], surgery was most likely to occur in patients with WBC >12 c/mm 3 and/or emesis in the >60-year-old age group.…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

Muhammad

Sadough

King

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Pneumatosis intestinalis is a radiographic finding that represents a spectrum of conditions ranging from benign disease to abdominal sepsis and death. Along with portal venous gas, it is generally considered an ominous sign prompting emergency operative intervention. We report a rare case showing that nonoperative therapy can be considered in a seriously ill patient with esophageal, gastric and portal venous air.

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Section: Discussionmentioning

confidence: 99%

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

Muhammad

Sadough

King

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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“…Se o doente mantiver sintomas, como no caso exposto, estão indicadas outras opções terapêuticas como antibióticos, em particular o metronidazol -eficaz contra bactérias anaeróbias, 8 dieta elementar, cuja eficácia está presumivelmente associada à alteração da flora intestinal 9 ; oxigenoterapia normo ou hiperbárica -além de ser tóxi-ca para as bactérias anaeróbias, a elevada concentração de oxigénio no sangue aumenta a sua pressão parcial e diminui a pressão parcial dos restantes gases criando um gradiente de difusão através da parede dos quistos 10 ; ressecção cirúrgica da área intestinal afetada (principalmente se houver oclusão intestinal) 11 ; ou terapêutica endoscópica através de punção e escleroterapia dos quistos, nos doentes com sintomas obstrutivos e sem condições cirúrgicas.…”

Section: Discussionunclassified

Pneumatose Cólica Tratada com Metronidazol e Oxigenoterapia Hiperbárica: Um Caso de Sucesso

et al. 2015

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Acta Med Port 2015 Jul-Aug;28(4):534-537 RESUMOA pneumatose intestinal, caracterizada pela presença de gás na parede do cólon, é uma condição incomum com um espectro de apresentação variável. Pode ser idiopática ou secundária a outras doenças. A tomografia computorizada é o método de diagnóstico com maior sensibilidade. Na ausência de sinais e sintomas sugestivos de complicações, como a perfuração e a peritonite, a pneumatose intestinal pode ser tratada de forma conservadora. Apresenta-se o caso de uma mulher de 59 anos com pneumatose cólica secundária a teratoma ovárico benigno. Após a cirurgia, manteve-se sintomática e foi tratada com sucesso com metronidazol e oxigenoterapia hiperbárica. Palavras-chave: Metronidazol; Oxigenação Hiperbárica; Pneumatose Cistoide Intestinal. ABSTRACTPneumatosis intestinalis, characterized by the presence of gas within the bowel wall, is an uncommon condition with variable presentation. It may be idiopathic or secondary to other diseases. A computed tomography scan is the most sensitive method for diagnosis. In the absence of signs and symptoms of complications, such as perforation and peritonitis, pneumatosis intestinalis can be managed conservatively. We present the case of a 59-year-old woman with pneumatosis coli secondary to benign ovary teratoma. After surgery she remained symptomatic and was successfully treated with metronidazole and hyperbaric oxygen therapy.

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“…11 Proven PI in conjunction with a serum lactic acid level exceeding 2 mmol/L entails a high rate of fatal outcomes, of over 80%. 12 Thus, transplant physicians should be well-versed in differentiating the fatal form of PI from a benign one.…”

Section: Introductionmentioning

confidence: 99%

Untitled

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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Pneumatosis Intestinalis in Adults: Management, Surgical Indications, and Risk Factors for Mortality

Cited by 136 publications

References 15 publications

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

Pneumatose Cólica Tratada com Metronidazol e Oxigenoterapia Hiperbárica: Um Caso de Sucesso

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