Multicenter Epidemiological Survey of Pneumatosis Intestinalis in Japan

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.

Emphysematous Aortitis due to Clostridium septicum in an 89-Year-Old Female with Ileus

Emphysematous aortitis is a rare but lethal form of infectious vasculitis. This condition was found incidentally on computed tomography of the chest during the evaluation of a patient presenting with pneumonia coincident with adynamic ileus. The patient did not have a history of malignancy. While colon cancer could not be ruled out, it is possible that ileus may have contributed to or resulted in bacterial translocation in this case. Appropriate investigations and empirical therapy against Clostridium septicum should be initiated in the presence of clinical and radiological findings suggestive of emphysematous aortitis.

Treatment of Brain Injury-Associated Symptoms and Signs

Acute neurologic disease results in a myriad of minor and major symptoms, some of which are partly specific to the nature of the illness. Symptom relief for acutely ill neurologic patients requires medication orders. Treatment of these symptoms is not without adverse effects, and regular use of opioids to treat severe headaches may very often lead to opioid-induced constipation, which may progress to adynamic ileus. This chapter focuses on, nausea and vomiting, hiccups, secretion control, constipation, fever and shivering, and rhabdomyolysis. Large volumes of emesis or secretions can easily cause aspiration and mucus plugging of large bronchial branches. Drug regimens are discussed in detail.

Acute colonic pseudo-obstruction: Ogilvie syndrome

<p>Colonic pseudo-obstruction (Ogilvie’s syndrome) is a functional disorder in which the colon becomes massively dilated in the absence of mechanical obstruction. Pseudoobstruction most commonly occurs in hospitalized patients and is associated with the use of narcotics, bed rest, and comorbid disease. Pseudoobstruction is thought to result from autonomic dysfunction and severe adynamic ileus. The diagnosis is made based on the presence of massive dilatation of the colon (usually predominantly the right and transverse colon) in the absence of a mechanical obstruction.</p>