Successful treatment with hyperbaric oxygen therapy for pneumatosis cystoides intestinalis as a complication of granulomatosis with polyangiitis: a case report

Abstract

BackgroundAlthough gastrointestinal involvement in patients with granulomatosis with polyangiitis is uncommon, it is associated with mild to severe life-threatening complications. We present a case of pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis that was treated successfully with hyperbaric oxygen.Case presentationA 70-year-old Japanese man with a 3-year history of granulomatosis with polyangiitis consulted our hospital with a complaint of severe back pain. Computed tomography showed a large amount of gas located in his bowel wall and mesentery. He underwent urgent exploratory laparotomy, which led to a diagnosis of pneumatosis cystoides intestinalis without intestinal perforation or necrosis. He consequently underwent 13 sessions of hyperbaric oxygen therapy and was discharged from our hospital without complications.ConclusionsSeveral previous reports have supported the efficacy of hyperbaric oxygen for treating pneumatosis cystoides intestinalis. The present case, however, is the first in which pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis was successfully treated with hyperbaric oxygen. We therefore suggest that hyperbaric oxygen therapy could be a candidate treatment for pneumatosis cystoides intestinalis in patients with granulomatosis with polyangiitis.

Pneumatosis cystoides intestinalis: a case report and literature review

“…If a PCI is suspected, CT examination and ultrasound endoscopy should be performed when conditions permit, and the factors causing PCI should be explored. In addition to gastrointestinal diseases and emphysema, some rare events are associated to PCI, such as alpha-glucosidase inhibitors [7], sunitinib [20], lung transplantation [28], bone marrow transplantation [29], systemic lupus erythematosus [30], systemic sclerosis [11], myeloma [31], granulomatosis with polyangiitis [32]. Moreover, the mucosal damage caused by colonoscopy and biopsy may result in the gas entering the intestinal mucosa, thereby promoting the occurrence of PCI [33].…”

“…Most researchers believe that PCI is a benign disease with conservative treatments: (1) observation; (2) oxygen or hyperbaric oxygen therapy. Kensuke Nakatani et al reported that hyperbaric oxygen therapy is the preferred method [32]; (3) antibiotics including metronidazole and quinolones can inhibit intestinal bacterial infection; and (4) endoscopic treatment. Endoscopic fine needle aspiration contributes to the diagnosis and treatment of PCI, by puncturing the cyst to exhaust gas [34–37].…”

“Cystamatic” Review: Is Surgery Mandatory for Pneumatosis Cystoides Intestinalis?

“…The principal symptom was abdominal pain associated with the finding of free air under diaphragm. These [12] 65 years, M Secondary Intake of α-glucosidase inhibitors Takahashi et al [13] 17 years, F Idiopathic -Singh et al [14] N/A, F Secondary Systemic sclerosis Asahi et al [15] 67 years, M Secondary Neoplasm Uruga et al [16] 71 years, F Secondary Neoplasm Koysombat et al [17] N/A Secondary Systemic sclerosis Wang et al [18] 56 years, M Idiopathic -48 years, F Secondary Exposing to trichloroethylene 66 years, F Secondary Disease of immune system 72 years, F Secondary Diabetes 64 years, M Secondary Emphysema 24 years, F Secondary Neoplasm Martin-Lagos et al [19] 72 years, M Secondary Chemotherapy Suda et al [20] 80 years, M Idiopathic -Márquez Argente et al [21] 48 years, M Idiopathic de la Serna et al [22] 83 years, M Secondary Chemotherapy Mikami et al [23] 72 years, M Secondary Ulcerative colitis Sugihara et al [24] 48 years, F Secondary Therapy with glucocorticoid Kunishi et al [25] 84 years, M Secondary Intake of α-glucosidase inhibitors Lee et al [26] 68 years, F Secondary Chemotherapy Kang et al [27] 54 years, M Secondary COPD Nakatani et al [28] 70 years, M Secondary Granulomatosis with polyangiitis Rachapalli et al [29] 50 years, M Secondary Neoplasm Jegadeesan et al [30] 51 years, M Secondary Neoplasm Liao et al [31] 84 years, F Idiopathic -Suzuki et al [32] 71 years, F Secondary Connective tissue disease 70 years, F Secondary Connective tissue disease 70 years, M Secondary Connective tissue disease 42 years, F Secondary Connective tissue disease Iida et al [33] 79 years, M Secondary COPD Romano-Munive et al [34] 54 years, F Idiopathic -Venkataramani et al [35] 56 years, F Secondary Neoplasm Faria et al [36] 69 years, M Secondary Neoplasm Fujimi et al [37] 55 years, M Secondary Interstitial pneumonia with corticosteroid therapy Furihata et al [38] 81 years, M Idiopathic -Mima et al [39] 46 years, M Secondary Rheumatoid arthritis Torigoe et al [40] 77 ...…”

Neumatosis quística intestinal con neumoperitoneo encapsulado no quirúrgico: presentación de caso y revisión de la literatura

“…Fuente: archivo de los autores. casos el tratamiento puede ser conservador mediante observación y seguimiento (4,6,8) , oxigenoterapia hiperbárica (10) , antibióticos (metronidazol, tinidazol, rifaximina, quinolonas), probióticos tipo Bifidobacterium, terapia endoscópica como aspiración con aguja fina (6,11) o resección electroquirúrgica de alta frecuencia de las paredes quísticas o escleroterapia, sin recomendarse el uso de argón plasma debido a la posible explosión por metano (8) , y cambio de quimioterapéuticos (tipo citostáticos o terapias moleculares dirigidas e inhibidores de tirosina-cinasa para patología tumoral metastásica esofágica, pulmonar, renal o de otro tipo) (12) .…”