Case Report: Massive Intestinal Pneumatosis and Pneumoretroperitoneum Following Hematopoietic Stem Cell Transplantation in a 2-Year-Old Child

A 2-year-old boy with severe combined immunodeficiency (SCID) developed intestinal graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT), associated with massive intestinal pneumatosis (IP), pneumoretroperitoneum (PRP), and pneumomediastinum. His fair clinical conditions allowed conservative management, with progressive normalization of imaging findings. The patient did not require surgery and is alive and in good clinical conditions at follow-up. In children with GVHD-related IP but good clinical conditions and no signs of peritonitis, IP is not a mandatory indication for surgery, despite its potentially striking imaging features. Conservative management, with intestinal rest, decompression, and antibiotics, often allows regression of the clinical picture.

Is surgical exploration necessary in asymptomatic intestinal pneumatosis after lung transplantation?

Pneumatosis intestinalis is described as gas within the bowel wall and can be a sign of bowel ischaemia with a pending perforation. The described patient presented with the incidental diagnosis of pneumatosis intestinalis with free intraperitoneal gas on CT scan. His medical history included a successful lung transplantation. We here describe the clinical decision-making and evaluate our case with previous cases in the literature.

CASE REPORT OF A CHALLENGING CYSTIC INTESTINAL PNEUMATOSIS OF THE SMALL GUT ASSOCIATED WITH ULCER PERFORATION

Introduction:-Cystic Intestinal Pneumatosis represents a challenging clinical condition with various clinical onsets and complications. Altogether, CIP is prone to misdiagnosis and or mistreatment due to delayed management. The aim of our study is to report the challenging diagnosis of a pneumatosis intestinalis clinical case, the therapeutic strategy we chose to adopt and the outcome. Material and Methods:-Forty-five-year-old manwith no past medical and surgical history who presented aggravated acute abdominal pain and absence of bowel movement associated with vomitus in the last 5 days earlier. Physical examination unveiled unstable patient with cardiovascular choc syndrome and generalized abdominal contraction. Prompt medical care was started with abundant IV fluids repletion and antibiotics. Abdominal X-ray without barium showed the presence of air in the abdominal cavity. Diagnosis of pneumoperitoneum was confirmed, and due to the unstable condition, we decided to undergo surgical assessment first without abdominal CT scan. Therefore, laparotomy was carried on. We found perforated anterior duodenal ulcer associated with cystic bubbles filled with air along the gut wall. We decided to preserve the affected segment with cystic pneumatosis as there was no significant signs of inflammation, perforation nor ischemia. Post-operative course was uneventful, and the patient was discharged on day 5. Long-term follow-up at 4 months was uneventful. Discussion:-The abstract underlined the misleading radiology imaging of CIP, highly like the one of pneumoperitoneum. The etiology behind Pneumatosis intestinalis is yet to be understood. Multiple theories have been described, including mechanical disruption of mucosa, the spread of intraparietal gas to operate via lymphatic drainage, pulmonary pathogenesis and bowel necrosis, or finally idiopathic. Although it is a benign condition there arepotentially associated complications requiring both adequate diagnosis and management. Conclusion:-To the best of our knowledge, we report the third case in literature of associated cystic intestinal pneumatosis with perforated duodenal ulcer.Intestinal preservation in cystic intestinal pneumatosis seems to be the best suited approach, both in an elective setting and emergency setting. Though more clinical data and extend follow-ups on this matter should be held in order to affirm the safety of this approach.

Clostridium difficile Infection Leading to Intestinal Pneumatosis in a Patient with a Recent Diagnosis of Pancreatic Cancer Local Recurrence: A Case Report and Literature Review

<i>Clostridium difficile</i> infection (CDI) causing pneumatosis intestinalis (PI) is a rare event, described mostly in immunocompromised patients. We present the case of a 65-year-old female diagnosed with adenocarcinoma of the pancreas who underwent a duodenopancreatectomy with lymphadenectomy and adjuvant gemcitabine and capecitabine. Four months after the end of chemotherapy, she experienced abdominal pain and intermittent diarrhea which became aggravated within 6 months. CT scans revealed diffuse intestinal pneumatosis and recurrence of ductal adenocarcinoma. We hypothesize that local pancreatic cancer recurrence may lead to gastrointestinal dysmotility with consequent increased risk for CDI. The patient had almost complete resolution of PI during the CDI treatment, thus we believe that the CDI was directly responsible for PI in this case.

Spontaneous pneumoperitoneum secondary to intestinal pneumatosis: an uncommon cause of acute abdomen

Intestinal pneumatosis is a rare entity characterized by gas accumulation in the submucosa and or subserosa of the intestinal tract wall and is generally associated with other diseases, the primary presentation is rare. Most of the cases are asymptomatic, being infrequent the presentation as an acute abdomen secondary to a spontaneous pneumoperitoneum. We report the case of a patient with systemic sclerosis, who presented to the emergency department with abdominal pain and intestinal obstruction, without improvement to conservative treatment and with progression to acute abdomen, for which surgical treatment was performed showing intestinal pneumatosis that compromised the entire small intestine.

Pneumatosis intestinalis in a patient with trichobezoar – Rare association

This case report describes a young girl who presented with chronic epigastric pain and abdominal mass without noticeable psychiatric illness or trichotillomania and subsequently trichobezoar was found to be the reason for her symptoms. She underwent laparotomy to retrieve the bezoar. During laparotomy extensive pneumatosis of the small bowel was noted where this association was not previously reported in the literature. Since pneumatosis was not symptomatic no bowel resection was carried out. She made an uneventful recovery. This illustrates that trichobezoar is an important cause to consider in young females with chronic abdominal pain even in the absence of clear evidence for trichotillomania. Rarely, this can be associated with intestinal pneumatosis. Intestinal pneumatosis does not warrant treatment unless it causes symptoms. Keywords: Trichobezoar; epigastric pain; pneumatosis intestinalis; trichotillomania; pneumoperitoneum

Pneumatosis intestinalis in a radioactive iodine-refractory metastasic thyroid papillary carcinoma with BRAFV600E mutation treated with dabrafenib–trametinib: a case report

Background Pneumatosis intestinalis (PI) is a rare entity which refers to the presence of gas within the wall of the small bowel or colon which is a radiographic sign. The etiology and clinical presentation are variable. Patients with PI may present either with chronic mild non-specific symptoms or with acute abdominal pain with peritonitis. Some cases of intestinal pneumatosis have been reported as adverse events of new oncological treatments such as targeted therapies that are widely used in multiple tumors. Case presentation A 59-year-old caucasian female with radioactive iodine-refractory metastatic thyroid papillary carcinoma with BRAFV600E mutation was treated with dabrafenib and trametinib as a compassionate use. After 4 months treatment, positron emission tomography–computed tomography (PET–CT) showed PI. At the time of diagnosis, the patient was asymptomatic without signs of peritonitis. The initial treatment was conservative and no specific treatment for PI was needed. Unfortunately, after dabrafenib–trametinib withdrawal, the patient developed tumor progression with significant clinical worsening. Conclusions This case report is, in our knowledge, the first description of PI in a patient treated with dabrafenib–trametinib. Conservative treatment is feasible if there are no abdominal symptoms.