Pneumatosis intestinalis: Not always bowel ischemia

Lee, Adele; Tellambura, Shanthapriya

doi:10.1016/j.radcr.2022.01.062

Cited by 3 publications

(3 citation statements)

References 14 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While PI can have an ominous prognosis, there exists a wide spectrum in terms of severity, ranging from benign with a low risk of hospitalization to severely debilitating with a high mortality. This is due to PI having multiple possible sequelae, ranging from bowel obstruction to bowel ischemia [ 12 , 13 ]. The incidence of both PI with subsequent HPVG is very rare, with the most likely source identified by cohort studies to be bowel ischemia as per autopsy evaluations [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia?

Erdem,

Patel,

Patel

et al. 2023

Cureus

View full text Add to dashboard Cite

Pneumatosis intestinalis (PI) is a relatively rare gastrointestinal finding that has a wide variety of causesranging from benign to life-threatening. It is described as the pathological presence of gas within the bowel wall with multiple hypotheses emerging as to the likely mechanism. An important indicator of a lifethreatening source of PI is the presence of gas within the hepatic portal vein, referred to as hepatic portal venous gas (HPVG). While non-specific for isolated PI, HPVG has been reported in PI patients to be associated with bowel ischemia and is thereby considered an indication for emergent management. Herein we report a case involving an atypical presentation of altered mental status in which the patient was found to have PI with contemporaneous HPVG. These findings have been reported to have a high mortality rate. Our patient rapidly deteriorated during their hospital course, expiring shortly after being deemed a poor surgical candidate due to their severe co-morbidity burden. Through this case, we review evidence supporting the management of patients with PI and concurrent HPVG from an extensive review of available literature. While PI is a non-specific finding and commonly a source of diagnostic confusion, a better understanding of its natural course and potentially unorthodox sequela may afford more directed and crucial care for critically ill patients, in which time is often a precious commodity.

show abstract

Section: Discussionmentioning

confidence: 99%

Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia?

Erdem,

Patel,

Patel

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Se realizó cirugía diagnóstica en 26 pacientes (44,8 %). Hwee et al (17) (2022) Australia Reporte de caso…”

Section: Revisión Management Of Pneumatosis Cystoides Intestinalis Wi...unclassified

“…La IP puede encontrarse incidentalmente en pacientes asintomáticos; mientras que, algunos casos se presentan como dolor abdominal, diarrea, distensión abdominal, estreñimiento, sangre en las heces, flatos, pérdida de apetito, pérdida de peso, e incluso enfermedades potencialmente mortales, como necrosis intestinal y perforación. (17,7) El diagnóstico de IP, generalmente proviene de una radiografía abdominal de manera incidental encontrándose bolsas de gas radiotransparentes, en forma de racimos de uvas o con forma de panal, a lo largo de la pared del intestino. (18) En pacientes seleccionados, la adición de una tomografía computarizada abdominal (modalidad de imagen más sensible para el diagnóstico) puede permitir la identificación de signos adicionales que reflejen la gravedad de la patología y determinar la etiología subyacente o identificar complicaciones que pueden alterar el curso de la terapia, como el engrosamiento de la pared intestinal, otra acumulación de gas, pared intestinal patológica o realce de contraste de tejidos blandos, dilatación de la luz intestinal, líquido en la cavidad peritoneal y gas en la vena porta; sin embargo, los hallazgos de la TC no son patognomónicos de Presión Intra Craneal (PIC).…”

Section: Diagnósticounclassified

Intestinal pneumatosis: a problem of misdiagnosis

Gaguancela-Sabando,

Dávalos-Barzola

2023

Salud, Ciencia y Tecnología

View full text Add to dashboard Cite

Introducción: La neumatosis intestinal, patología en pared intestinal asociada a distintas condiciones clínicas subyacentes, por acumulación de gases que generan enfermedades inflamatorias, frecuentemente relacionada con estado de emergencia del paciente, requiriendo diagnóstico rápido. Objetivo: Describir los aspectos relevantes de la Neumatosis Intestinal como problema derivado de un mal diagnóstico, a fines de reducir el índice de morbimortalidad en pacientes con patología aguda. Métodos: Artículo de revisión bibliográfica, apoyado en metodología documental, mediante compilación de información en bases de datos digitales: Pubmed, SciELO, Science Direct y Google Académico, recurriendo a descriptores en Ciencias de la Salud (DeCS), con criterio de inclusión de artículos publicados entre los años 2017-2022, en inglés y español. Resultados: Apuntan hacia la manifestación de la patogenia, aún por determinarse con exactitud, dadas las múltiples causas y patologías relacionadas que pueden complicar el hallazgo a tiempo, convirtiéndose en reto médico diario con pacientes inclusive asintomáticos. Igualmente, la realización de valoraciones invasivas puede comprometer la exploración intraperitoneal en determinados casos, siendo necesario complementar con otros métodos para obtener mejor diagnóstico. Conclusiones: La realización de imagenología se considera idónea para verificar un diagnóstico de IP, específicamente las tomografías computarizadas, en virtud que pueden demostrar los detalles internos en la pared del intestino, pudiendo evidenciar tres patrones de neumatosis, los cuales son reseñados por la literatura a través de burbujas cistoides, patrones lineales y circulares, siendo vinculantes para el adecuado diagnóstico a tiempo que coadyuven a disminuir las conmorbilidades y evitar los índices de morbimortalidad actuales.

show abstract

Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus

McKinley

Santiago

Pak

et al. 2022

JCM

View full text Add to dashboard Cite

Alpha-glucosidase inhibitor (αGIs)-induced pneumatosis intestinalis (PI) has been narrated in case reports but never systematically investigated. This study aimed to investigate the concurrency of PI and αGIs. A literature search was performed in PubMed, Google Scholar, WorldCat, and the Directory of Open-Access Journals (DOAJ) by using the keywords “pneumatosis intestinalis”, “alpha-glucosidase inhibitors”, and “diabetes”. In total, 29 cases of αGIs-induced PI in 28 articles were included. There were 11 men, 17 women, and one undefined sex, with a median age of 67. The most used αGI was voglibose (44.8%), followed by acarbose (41.4%) and miglitol (6.8%). Nine (31%) patients reported concomitant use of prednisone/prednisolone with or without immunosuppressants. The main symptoms were abdominal pain (54.5%) and distention (50%). The ascending colon (55.2%) and the ileum (34.5%) were the most affected. Nineteen (65.5%) patients had comorbidities. Patients with comorbidities had higher rates of air in body cavities, the portal vein, extraintestinal tissues, and the wall of the small intestine. Only one patient was found to have non-occlusive mesenteric ischemia. Twenty-five patients were treated with conservative therapy alone, and two patients received surgical intervention. All patients recovered. In conclusion, comorbidities, glucocorticoids, and immunosuppressants aggravate αGIs-induced PI. Conservative therapy is recommended when treating αGIs-induced PI.

show abstract

Pneumatosis intestinalis: Not always bowel ischemia

Cited by 3 publications

References 14 publications

Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia?

Understanding the Nuances of Hepatic Portal Venous Gas in Pneumatosis Intestinalis: An Indication of Bowel Ischemia?

Intestinal pneumatosis: a problem of misdiagnosis

Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus

Contact Info

Product

Resources

About