scholarly journals Benign pneumatosis intestinalis: a cause of massive pneumoperitoneum in the adult

CJEM ◽  
2003 ◽  
Vol 5 (06) ◽  
pp. 416-420 ◽  
Author(s):  
David M. Liu ◽  
William C. Torreggiani ◽  
Kevin Rowan ◽  
Savvas Nicolaou
Keyword(s):  
Bowel Wall ◽  
Surgical Intervention ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Benign Condition ◽  
Distinguishing Features

ABSTRACT Pneumatosis intestinalis (gas in the bowel wall) is often a benign condition, but it may mimic bowel ischemia or infarction and lead to unnecessary surgical intervention, especially when associated with pneumoperitoneum. We present a case of benign pneumatosis intestinalis with massive pneumoperitoneum and discuss various distinguishing features that may aid in its diagnosis.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

scholarly journals A rare case of emphysematous pyelonephritis associated with pneumatosis intestinalis and bowel ischemia

2021 ◽  
Vol 38 ◽  
pp. 101685
Author(s):  
Albara Hariri ◽  
Abdulhkam Aljarbou ◽  
Khalid Albalawi ◽  
Saad Alqasem ◽  
Ibrahim Alowidah ◽  
...  
Keyword(s):  
Rare Case ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Emphysematous Pyelonephritis

Small Bowel Obstruction

2010 ◽  
Vol 21 (2) ◽  
pp. 187-194
Author(s):  
Colleen Trevino
Keyword(s):  
Small Bowel ◽  
Physical Examination ◽  
Surgical Intervention ◽  
Signs And Symptoms ◽  
Bowel Ischemia ◽  
Key Factors ◽  
The Past ◽  
Factors Influencing ◽  
Imaging Response

Strategies for the management of small bowel obstructions have changed significantly over the years. Nonoperative medical management has become the mainstay of treatment of many small bowel obstructions. However, the key to the management of small bowel obstructions is identifying those patients who need surgical intervention. Identification of those at risk for bowel ischemia and bowel death is an art as much as it is a science. Using the current literature and the past knowledge regarding small bowel obstructions, the clinician must carefully identify the signs and symptoms that suggest the need for operative intervention. Classification of the obstruction, history and physical examination, imaging, response to decompression and resuscitation, and resolution or progression of symptoms are the key factors influencing the management of small bowel obstructions.

Pneumatosis Intestinalis In Childhood Dermatomyositis

PEDIATRICS ◽  
1973 ◽  
Vol 52 (5) ◽  
pp. 711-712
Author(s):  
Miguel A. Oliveros ◽  
John J. Herbst ◽  
Patrick D. Lester ◽  
Fred A. Ziter
Keyword(s):  
Abdominal Pain ◽  
Muscle Wasting ◽  
Progressive Systemic Sclerosis ◽  
Pneumatosis Intestinalis ◽  
Gastrointestinal Complications ◽  
Benign Condition ◽  
History Of ◽  
The Right ◽  
Subcutaneous Calcification ◽  
Childhood Dermatomyositis

The gastrointestinal complications of dermatomyositis are well known. Reviews, however, do not mention pneumatosis intestinalis in this disorder).1-3 Although noted in progressive systemic sclerosis,4-7 its association with dermatomyositis has been documented in only one case,5 unreported in the pediatric literature. It is important to distinguish this apparently benign condition from pneumoperitoneum secondary to intestinal perforation, which is a grave complication of dermatomyositis.1 CASE REPORT W. W., an 8-8/12-year-old girl with a three-year history of dermatomyositis with prominent skin rash, disseminated subcutaneous calcification, muscle wasting and induration, also complained of occasional abdominal pain, recently localized to the right hypochondriurn and right shoulder. Inspite of continuous prednisone treatment and intermittent trials of azathioprine, methotrexate, and cyclophosphamide the patient's disease failed to remit.

PS02.152: DEVELOPMENT OF INTESTINAL PNEUMATOSIS AND PORTAL VENOUS GAS AFTER ESOPHAGECTOMY IS NOT INDICATIVE OF ISCHEMIC BOWEL AND CAN BE SUCCESSFULLY MANAGED NON-OPERATIVELY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 164-164
Author(s):  
Erin Gillaspie ◽  
Micheal Moynagh ◽  
Sameh Said ◽  
Mark Allen ◽  
Shanda Blackmon ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Case Series ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Tube Placement ◽  
Jejunostomy Tube ◽  
Radiographic Findings ◽  
Intestinal Pneumatosis ◽  
Ischemic Bowel ◽  
Portal Venous Gas

Abstract Background Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic findings on re-exploration. Methods January 2000 to December 2017, 1760 patients underwent Ivor-Lewis esophagectomy or gastrectomy with jejunostomy-tube placement. Charts were reviewed retrospectively to identify patients with pneumatosis intestinalis discovered in the post-operative period. Demographic data, operative details and postoperative course were reviewed including incidence and details of re-exploration. Results Eleven patients met inclusion criteria. Nine were male (81.8%) and mean age was 69 years. All patients had radiographic confirmation of pneumatosis intestinalis and in many cases portal venous gas (Figure 1). Clinical course was variable without discernable trends in vitals or laboratory values. Development of significant postoperative ileus along with delivery of enteral tube feeds through a jejunostomy tube preceded development of the pneumatosis in all patients. Nine patients were re-explored and none had evidence of bowel ischemia. Conclusion The finding of pneumatosis intestinalis in the post-operative setting can be alarming and pose a management dilemma. With the advent of improved and readily available imaging, there has been an increase in findings that have no corollary physical symptomatology. In this series of patients, despite dramatic radiographic findings, none had ischemic bowel. Pneumatosis intestinalis alone in patients who have undergone esophagectomy should not be considered an indication for emergency re-exploration. Disclosure All authors have declared no conflicts of interest.

scholarly journals Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

2018 ◽  
Vol 64 (6) ◽  
pp. 543-548 ◽  
Author(s):  
Sujin Ko ◽  
Seong Sook Hong ◽  
Jiyoung Hwang ◽  
Hyun-joo Kim ◽  
Yun-Woo Chang ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Statistical Significance ◽  
Pneumatosis Intestinalis ◽  
Bowel Distension ◽  
Wall Defect ◽  
Ct Findings ◽  
Free Air ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Ct Features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

scholarly journals Antineutrophil Cytoplasmic Antibody–associated Glomerulonephritis Complicated by Pneumatosis Intestinalis

2015 ◽  
Vol 8 ◽  
pp. CCRep.S26155 ◽  
Author(s):  
Saki Nakagawa ◽  
Tetsu Akimoto ◽  
Shin-ichi Takeda ◽  
Mari Okada ◽  
Atsushi Miki ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Bowel Wall ◽  
Pneumatosis Intestinalis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Current Case ◽  
Anca Associated Vasculitis ◽  
Characteristic Imaging

Pneumatosis intestinalis is a characteristic imaging phenomenon indicating the presence of gas in the bowel wall. The link between pneumatosis intestinalis and various kinds of autoimmune diseases has been reported anecdotally, while information regarding the cases with antineutrophil cytoplasmic antibodies (ANCA)–associated vasculitis complicated by concurrent pneumatosis intestinalis is lacking. In this report, we describe our serendipitous experience with one such case of pneumatosis intestinalis in a patient with ANCA-associated glomerulonephritis. We also discuss several therapeutic concerns that arose in the current case, which had an impact on the pathogenesis of the disease.

Extensive Portal Venous Gas and Pneumatosis Intestinalis in the Absence of Small Bowel Ischemia or Infarction

2007 ◽  
Vol 102 ◽  
pp. S373-S374
Author(s):  
Pavan K. Pinnamaneni ◽  
Parupudi V.J. Sriram ◽  
David Hodges ◽  
Ari Halldorsson
Keyword(s):  
Small Bowel ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Portal Venous Gas

scholarly journals Pneumatosis Cystoides Intestinalis after Cetuximab Chemotherapy for Squamous Cell Carcinoma of Parotid Gland

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Christos Petrides ◽  
Neofytou Kyriakos ◽  
Ioannou Andreas ◽  
Parpounas Konstantinos ◽  
Georgiou Chrysanthos ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Bowel Wall ◽  
Gastrointestinal Disease ◽  
Radiographic Finding ◽  
Pneumatosis Intestinalis ◽  
Ct Scans ◽  
Abdominal Radiographs ◽  
Cetuximab Therapy

Pneumatosis intestinalis, defined as gas in the bowel wall, is often first identified on abdominal radiographs or computed tomography (CT) scans. It is a radiographic finding and not a diagnosis, as the etiology varies from benign conditions to fulminant gastrointestinal disease. We report here a case of pneumatosis intestinalis associated with cetuximab therapy for squamous cell carcinoma of head and neck. The patient underwent laparotomy based on the CT scan and the result was pneumatosis intestinalis without any signs of necrotizing enterocolitis.

Management of pneumatosis intestinalis in children over the age of 6 months: a conservative approach

2017 ◽  
Vol 103 (4) ◽  
pp. 352-355 ◽  
Author(s):  
Leel Nellihela ◽  
Mohamed Mutalib ◽  
David Thompson ◽  
Kammermeier Jochen ◽  
Manasvi Upadhyaya
Keyword(s):  
Surgical Intervention ◽  
Incidental Finding ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Successful Outcome ◽  
Bowel Ischaemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Peroxisomal Biogenesis ◽  
Asymptomatic Individuals

BackgroundPneumatosis intestinalis (PI) is an uncommon and poorly understood condition. Although it can be an incidental finding in asymptomatic individuals, it can also be secondary to life-threatening bowel ischaemia and sepsis. In premature infants, it is a pathognomonic sign of necrotising enterocolitis. There is no consensus regarding management and long-term outcome of children with PI.AimReview of our experience of PI in children beyond the early infantile period.MethodsRetrospective review of patient’s records and radiological images from 2013 to 2015.ResultsEighteen patients (three girls) had radiologically confirmed PI. The median age was 4.5 years (range 8 months–13 years). Background medical conditions (number): short bowel syndrome (one), congenital heart disease (two), sickle cell disease (one), epilepsy (three), cerebral palsy (six), myotonic dystrophy (four) and peroxisomal biogenesis defect (one).Six children (33%) presented with abdominal distension, four (22%) with abdominal pain, three (17%) with bilious vomiting, two (11%) with diarrhoea and one (6%) with rectal bleeding. Two (11%) were asymptomatic. One had air in portal vein and two had pneumoperitoneum.All patients with symptomatic PI were treated conservatively with successful outcome and complete resolution of PI. None required surgical intervention.ConclusionPI in children who are not on chemotherapy or immunosuppressant appears to follow a benign course and is responsive to conservative management. In contrast to adults, portal venous gas and pneumoperitoneum do not predict the need for surgical intervention.

Sign in / Sign up

Export Citation Format

Share Document