Multicenter Epidemiological Survey of Pneumatosis Intestinalis in Japan

Abstract Background Pneumatosis intestinalis (PI) is a rare condition characterized by gas collection in the intestinal wall. We aimed to determine the etiology and affected segments associated with complications, treatment, and outcome. Methods We conducted a multicenter epidemiological survey using a standardized data collection sheet in Japan. Complicating PI was defined as strangulation or bowel necrosis, bowel obstruction, adynamic ileus, sepsis, shock, and massive gastrointestinal bleeding. Results We enrolled 167 patients from 48 facilities. Multivariate analysis revealed that older age (adjusted OR, 1.05 and 95% confidence intervals [CI], 1.02-1.09, P=0.0053) and chronic kidney disease (adjusted OR, 13.19 and 95% CI, 1.04-167.62, P=0.0468) were independent predictors of the small-bowel-involved type. Complicating PI was associated with the small-bowel-involved combined type (adjusted OR, 45.49 and 95% CI, 8.34-248.13, P<0.0001), the small-bowel-only type (adjusted OR, 7.90 and 95% CI, 1.92-32.56, P=0.0042), and allopurinol/benzbromaron (adjusted OR, 31.07 and 95% CI, 1.70-567.28, P=0.0204). Oxygen therapy was performed in patients with a past history of bowel obstruction (adjusted OR, 13.77 and 95% CI, 1.31-144.56, P=0.0288) and surgery was performed in patients with complicating PI (adjusted OR, 8.93 and 95% CI, 1.10-72.78, P=0.0408). Antihypertensives (adjusted OR, 12.28 and 95% CI, 1.07-140.79, P=0.0439) and complicating PI (adjusted OR, 11.77 and 95% CI, 1.053-131.526; P=0.0453) were associated with exacerbation of PI. The complicating PI was the only indicator of death (adjusted OR, 14.40 and 95% CI, 1.09-189.48, P=0.0425). Discussion This study provides evidence supporting the association between the small-bowel-involved type and complications and poor prognosis.

Download Full-text

S3565 When Clinical Correlation Is Key: A Case of Pneumatosis Intestinalis and Recurrent Small Bowel Obstruction in a Benign Abdomen

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000716308.34694.99 ◽

2020 ◽

Vol 115 (1) ◽

pp. S1841-S1841

Author(s):

Adam Jacobs ◽

Anita Singh ◽

Vikas Sethi

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Pneumatosis Intestinalis ◽

Clinical Correlation

Download Full-text

Intestinal Malrotation with Midgut Volvulus leading to Small Bowel Obstruction in a Young Adult: A Case Report

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v9i2.520 ◽

2020 ◽

Vol 9 (2) ◽

pp. 149-152

Author(s):

Junaid Zia Hashmi ◽

Talha Kareem ◽

Masood ur Rauf Khan Hiraj

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Iliac Fossa ◽

Rare Condition ◽

Intestinal Malrotation ◽

Uneventful Recovery ◽

Midgut Volvulus ◽

Left Iliac Fossa ◽

Ladd’S Procedure

The developing intestine rotates around the superior mesenteric vessels during physiological herniation from 6th to 10th weeks of embryogenesis. Intestinal malrotation leading to midgut volvulus and small bowel obstruction is a rare condition. Patients who develop this condition usually present in the first year of their life. Intestinal malrotation is characterized by right sided duodenojejunal junction, caecum in left iliac fossa and a narrow mesentery. Ladd’s procedure is the treatment of choice which is done to restore the normal anatomy. We report the case of an 18-year-old male patient, who presented with intestinal malrotation in emergency department of Nishtar Hospital, Multan. It is an uncommon age for presentation of this anomaly. The patient had fecal peritonitis due to caecal perforation. He underwent Ladd’s procedure in which ileocolostomy was made after right hemicolectomy. The patient had an uneventful recovery after the surgery and had no complaints on follow up visit one week after the discharge.

Download Full-text

Abdominal cocoon, a rare cause of intestinal obstruction: a case report and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20174900 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3753

Author(s):

Alaa Sedik ◽

Mufid Maali ◽

AbdelMajid ElShamary ◽

Fahed ElShamary

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Good Condition ◽

Rare Condition ◽

Anastomotic Site ◽

Abdominal Cocoon ◽

Acute Small Bowel Obstruction ◽

Encapsulating Peritonitis ◽

Symptoms And Signs ◽

Indian Male

Abdominal cocoon syndrome or sclerosing encapsulating peritonitis is a rare condition that indicates that a part or whole small bowel is encased in a fibro collagenous membrane or cocoon leading to acute or chronic bowel obstruction. Approximately 50 cases have been reported in literature. Patients usually present with a picture of bowel obstruction and most cases are diagnosed during laparotomy. Herein, we present a 31 years old Indian male presented with symptoms and signs of acute small bowel obstruction that proved to be due to an abdominal cocoon intraoperatively. Our patient underwent resection with stapled side to side anastomosis. He was readmitted again with a single intraperitoneal collection; near the anastomotic site; that was managed percutaneously. He was discharged in a good condition and was seen later in the surgery clinic free of symptoms. Early diagnosis with radiological guidance and surgical intervention may reduce morbidity of the condition.

Download Full-text

Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

Acute and Critical Care ◽

10.4266/acc.2016.00311 ◽

2019 ◽

Vol 34 (1) ◽

pp. 81-85

Author(s):

Dong Joon Kim ◽

Yong Joon Choi ◽

Young Sun Yoo

Keyword(s):

Mechanical Ventilation ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Pneumatosis Intestinalis ◽

Bowel Ischemia

Download Full-text

Pneumatosis Intestinalis in a Patient with Acute Promyelocytic Leukemia

Case Reports in Hematology ◽

10.1155/2015/576042 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Abhishek Mangaonkar ◽

Joshua Mansour ◽

Ryan Keen ◽

Tarun Kukkadapu ◽

Rohini Chintalapally ◽

...

Keyword(s):

Acute Promyelocytic Leukemia ◽

Conservative Management ◽

Rare Condition ◽

Pneumatosis Intestinalis ◽

Intestinal Wall ◽

Promyelocytic Leukemia ◽

Descending Colon

Pneumatosis Intestinalis is a rare condition characterized by the presence of gas within the intestinal wall. We describe a case of a 33-year-old woman with acute promyelocytic leukemia who developed nausea and nonbloody diarrhea. CT showed intramural air in transverse and descending colon. Patient clinically improved with conservative management.

Download Full-text

Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

Frontiers in Medicine ◽

10.3389/fmed.2021.638075 ◽

2021 ◽

Vol 8 ◽

Author(s):

Santiago J. Miyara ◽

Lance B. Becker ◽

Sara Guevara ◽

Claudia Kirsch ◽

Christine N. Metz ◽

...

Keyword(s):

New York ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Case Series ◽

Rare Condition ◽

Experimental Treatment ◽

Pneumatosis Intestinalis ◽

Protective Role ◽

Intestinal Wall ◽

Single Center

This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia–reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.

Download Full-text

Neumatosis intestinal. Rara presentación de abdomen agudo

Revista Argentina de Cirugía ◽

10.25132/raac.v111.n4.1422es ◽

2019 ◽

Vol 111 (4) ◽

pp. 302-304

Author(s):

Fabiana B. Mazzei ◽

◽

Nicolás F. Mazzei ◽

Carolina Magraht ◽

Diego M. Fusco ◽

...

Keyword(s):

Computed Tomography ◽

Mesenteric Ischemia ◽

Rare Condition ◽

Pneumatosis Intestinalis ◽

Intestinal Wall ◽

The Other ◽

Ct Scans ◽

Bowel Necrosis ◽

Rebound Tenderness ◽

Portal Venous Gas

Pneumatosis intestinalis is a rare condition characterized by the presence of gas in the submucosa or subserosa of the intestinal wall. We report two cases associated with generalized abdominal pain and rebound tenderness. The computed tomography (CT) scans in both cases showed bowel distention, pneumatosis intestinalis and portal venous gas. Both patients underwent emergency surgery which demonstrated bowel necrosis with mesenteric ischemia, consistent with the CT images. Both patients died (one during surgery and the other in the immediate postoperative period).

Download Full-text

Acute small bowel obstruction caused by phytobezoar Meckel diverticula

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-172-12-118-121 ◽

2019 ◽

pp. 118-121

Author(s):

S. V. Tarasenko ◽

A. A. Natal`skij ◽

O. D. Peskov ◽

A. Yu. Bogomolov ◽

P. V. Tarakanov

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Adult Population ◽

Rare Condition ◽

Acute Intestinal Obstruction ◽

Meckel Diverticulum ◽

Surgical Department ◽

Acute Small Bowel Obstruction

Introduction. Meckel diverticulum-is a residue of not completely reduced yolk duct. Among the occurring complications of Meckel’s cuticle in the adult population, acute intestinal obstruction prevails. In this case, the most common intussusception and inversion of the intestines. The occurrence of small bowel obstruction due to phytobesoar in the Meckel diverticulum is a rare condition and has been described in the literature in isolated cases. Materials and methods. The patient of 29 years entered the surgical Department with complaints of abdominal pain of a permanent nature, violation of the discharge of stool and gases, vomiting up to 4 times. Sick for about 2 days. Fluoroscopy of the abdomen showed multiple arches with small bowel fluid levels, single bowl kloybera. The man was operated on urgently with a diagnosis of acute mechanical small bowel obstruction. Results. During the operation, Meckel’s phytobezoar diverticula was detected, which caused acute small bowel obstruction, for which the fragmentation of the bezoar was performed with its relegation to the cecum. The postoperative period proceeded without complications, the patient was discharged on the 10th day after surgery. After 6 weeks, the patient underwent laparoscopic diverticulectomy as planned. Discharged for 5 days. Conclusion. A clinical case of treatment of a patient with phytobezoar Meckel diverticulum complicated by acute mechanical small bowel obstruction is presented. The use of delayed diverticulectomy can reduce the risk of anastomosis failure in acute intestinal obstruction, and if proper diet is observed, it reduces the risk of recurrent intestinal obstruction before re-planned hospitalization.

Download Full-text

An intraoperative diagnosis of sclerosing encapsulating peritonitis: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa329 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Jonathan Sivakumar ◽

Gregor Brown ◽

Laurence Galea ◽

Julian Choi

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Case Reports ◽

Fibrous Tissue ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Intraoperative Diagnosis ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

Abstract Primary sclerosing encapsulating peritonitis (SEP) is an idiopathic and rare condition characterized by chronic peritoneal inflammation. We describe the case of an intraoperative diagnosis of SEP, presenting as a mimicker of small bowel obstruction. The patient was a 59-year-old male with suspected small bowel obstruction. On exploratory laparotomy, it was noted that there was thick fibrous tissue involving the visceral and parietal peritoneum enveloping grossly dilated loops of small bowel. This case reports on the histopathological features of peritoneal biopsies as well as radiological findings. There is no consensus regarding the standard management for idiopathic SEP. The present case demonstrates a significant improvement in the patient’s condition with conservative management alone. A critical teaching point is that in the absence of an obvious cause, SEP is a rare but important differential diagnosis for surgeons to consider in the context of recurrent bowel obstruction.

Download Full-text