Emphysematous gastritis

An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton pump inhibitor, and broad-spectrum antibacterial agents.

Intramural Gas: Would it be Life-threatening?

The CECT scan of the abdomen at axial and coronal views show gas bubbles tracking along the inner wall of the ascending colon and hepatic flexure, which is separated from the intraluminal gas within the bowel. These intramural gas bubbles appear to be outlining the bowel wall circumferentially. The bowel wall appears to be thickened however the inner mucosa is not enhanced. There are no ascites in the images provided. The colon of the hepatic flexure and transverse colon appears dilated. No significant atherosclerotic plaque in the visualised arteries. Based on the clinical presentations and CECT features in Figure 1 and Figure 2, the best diagnosis for him is benign pneumatosis intestinalis (PI) secondary to obstructed low rectal cancer. He was subjected for a trephine transverse colostomy to relieve the obstruction with simultaneous transanal rectal mass biopsy. Once the histology is available, he subsequently will be referred for concurrent chemo-radiotherapy as neoadjuvant treatment and later for a low anterior resection, provided that it is a localized disease.

Pneumatosis Coli Formation via Counterperfusion Supersaturation in a Patient with Severe Diarrhea

We present the case of an elderly male patient with known multiple myeloma who was hospitalized with profuse watery diarrhea and abdominal pain after a course of induction chemotherapy. Intestinal intramural gas was found on imaging and the diagnosis of pneumatosis intestinalis was confirmed by colonoscopy. We propose counterperfusion supersaturation as the etiology for this patient’s pneumatosis coli via disruption of homeostasis between nitrogen and hydrogen normally present in the bowel. His condition was successfully treated with antidiarrheal medications and inhaled oxygen as well as intravenous hydration, and he eventually completed multiple myeloma directed chemotherapy with an excellent response. In this report, we discuss how clinicians can improve management of pneumatosis intestinalis by understanding the proposed pathophysiology.

Pneumatosis coli in a dog – a serial radiographic study: a case report

A 12-year-old intact female poodle was presented with a history of an acute episode of tenesmus and passage of ribbon-shaped stools. Anaemia, leucocytosis, hypoalbuminaemia, hyperglycaemia, and elevated ALP were found. Faecal floatation and wet mount preparation were negative for parasites. Anaerobic faecal culture resulted in a heavy growth of Clostridium. Survey abdominal radiographs revealed extensive intramural emphysema of colon and rectum. Ultrasonography of the abdomen revealed bright echoes within the layers of the colon wall, confirming the accumulation of intramural gas. Abdominal computed tomography revealed extraluminal gas tracking along the colon and the rectum. Based on the radiographic, ultrasonographic, and computed tomographic findings, the present case was diagnosed as pneumatosis coli with an underlying cause of bacterial overgrowth. The patient was treated with antibiotics for seventeen days. Clinical signs were resolved after three days of treatment. Decreased intramural gas accumulation was evident during radiography of the abdomen performed at fourteen days after the initial evaluation. Therefore, pneumatosis coli should be considered when a dog is presented with clinical signs of colitis.