Pneumatosis cystoides intestinalis pci is a rare selflimiting condition characterized by airfilled cysts within intestinal walls. Pneumatosis cystoides intestinalis journal of lung health and. Pneumatosis cystoides intestinalis libre pathology. Her vital signs were stable, and she had no signs of peritoneal irritation. The presenting clinical picture may be very heterogeneous and represent a challenge for the clinician. Necrotizing entercolitis is most common in premature newborns, and can causes bloody diarrhea, distension, and vomiting. Aircontaining, cystic lucencies are seen in bowel wall in proximal descending colon white circle and in the wall of the large bowel in the lower abdomen black arrows. Pneumatosis cystoides intestinalis lipomatosisa case report. The term pneumatosis cystoides coli is synonymous with pneumatosis cystoides intestinalis when the disorder is limited to the colon. Dec 12, 2014 pneumatosis intestinalis pi is defined as the presence of extraluminal gas confined to the bowel wall. Pneumatosis intestinalis is an imaging phenomenon representing the presence of gas in the bowel wall. Diagnosis should be prudent because it can mimic pneumoperitoneum leading to unnecessary treatment such as surgical exploration.
Pneumatosis intestinalis has been increasingly detected in recent years with the more frequent use of computed tomography for abdominal imaging of the intestine. Pneumatosis intestinalis can be due to benign or lifethreatening causes, but the imaging appearance of both may look very similar. Successful treatment of pneumatosis intestinalis with. Although various drugs including antineoplastic agents have been suggested as etiologies, cases related to sunitinib. May, 2019 pneumatosis intestinalis pi refers to the presence of gas within the wall of the small or large intestine. Pneumatosis cystoides intestinalis after systemic chemotherapy. Pneumatosis intestinalis an overview sciencedirect topics. B, spot film images from aircontrast barium enema show polypoid filling defects arrows due to gas in bowel wall arrowheads from pneumatosis cystoides intestinalis. In general, treatment of pi consists of treating the underlying disease. Pneumatosis intestinalis was defined as a radiographic diagnosis by lerner and gazin as early as 1946. Pneumatosis cystoides intestinalis is a rare gastrointestinal complication in the course of connective tissue diseases, especially in scleroderma, that can lead to pneumoperitoneum or obstruction. Nov 28, 2011 pneumatosis cystoides intestinalis pci is a rare condition that may be associated with a variety of diseases. The bacterial etiology of pneumatosis cystoides intestinalis.
Pneumatosis cystoides intestinalis of the ascending colon. A case revealing the typical macroscopic appearance of pneumatosis intestinalis is presented. Because pci is associated with a variety of treatments and both benign and lifethreatening conditions, its cause must be identified to ensure that the patient receives proper treatment. The circular form of pi is usually benign and most often seen with pneumatosis cystoides intestinalis pci. The spectrum of pneumatosis intestinalis radiology.
Other names applied to the condition include intestinal emphysema, peritoneal pneumatosis, pneumatosis cystoides intestinorum, and gas cysts of the abdomen. Information and translations of pneumatosis cystoides intestinalis in the most comprehensive dictionary definitions resource on the web. Since its first description, pi has appeared in the literature under many names, including pneumatosis cystoides intestinalis. Abdominal angiotomography identified diffuse pneumatosis intestinalis with a. Pneumatosis intestinalis pi is defined as the presence of extraluminal gas confined to the bowel wall. Infants with the condition are likely to also experience necrotizing enterocolitis, or death of intestine tissue. Pneumatosis cystoides intestinalis pci is a lowincidence disease that confuses many doctors. The underlying causes of the gas can vary widely and different hypotheses regarding. Presented here is a case report of a patient who was admitted with acute abdomen and was operated upon. There are different terminologies in the medical literature, such as pneumatosis intestinalis, pneumatosis coli, and pneumatosis cystoides intestinalis. Pneumatosis cystoides intestinal is of the small bowel are conditions in which multiple gas filled cysts are seen in the gut without any definite evidence of. In particular, the cysts are located beneath the serosa and mucosa of the intestine with an increase, in recent years, of. Pneumatosis cystoides intestinalis pci is an uncommon condition of unknown cause characterized by the presence of gasfilled cysts within the walls of some portion of the gastrointestinal tract. Since its first description, pi has appeared in the literature under many names, including pneumatosis cystoides intestinalis, intramural gas, pneumatosis coli.
Learningradiology pneumatosis, cystoides, intestinalis. Pneumatosis cystoides intestinalis pci is characterized by gasfilled cysts in the intestinal submucosa and subserosa. The spectrum of pneumatosis intestinalis radiology jama. A systematic analysis of pneumatosis cystoids intestinalis. Pneumatosis cystoides intestinalis is a rare condition in which multiple gasfilled cysts are found within the wall of the gastrointestinal tract either in the subserosa or submucosa. Pneumatosis cystoides intestinalis pci refers to the presence of air within the wall of the small intestine or colon. Pneumatosis cystoides intestinalis pci is an uncommon complication in which submucosal or subserosal gas cysts form in the bowel wall.
It is defined as air filled cysts within the wall of the gastrointestinal tract. Pathology outlines pneumatosis cystoides intestinalis. In one case, this finding was associated with a cecal perforation 83, whereas it was benign in others 98, 99. It was first recognized by duvernoi in 1730 during a cadaver dissection, and there have since been numerous reports of various underlying diseases 17. Pci was first described by duvernoi in 1783 and later subcategorized by koss in 1952. Although various drugs including antineoplastic agents have been suggested as etiologies, cases related to sunitinib are sparse. Findings on plain radiography may reveal radiolucent linear or bubbly circular air bubbles in the bowel wall, with or without free gas accumulation in the peritoneal cavity.
In pneumatosis cystoides intestinalis pci airfilled cysts are pres ent in the bowel wall and mesentery, and may oc cur any where in the gas tro in tes ti nal tract 9. Intramural gas can also affect the stomach, but this condition is referred to as gastric pneumatosis 1. Pneumatosis cystoides intestinalis associated with. The underlying causes of the gas can vary widely and different hypotheses. Pneumatosis cystoides intestinalis pci, also termed pneumatosis intestinalis, pneumatosis coli when occurring in colon only, and several other uncommon names in the literature, is a rare condition characterized by multiple gasfilled cystic spaces within the bowel wall. Pneumatosis cystoides intestinalis is characterized by multiple gas cysts in the wall of the gastrointestinal tract. Pneumatosis cystoides intestinalis presenting with gall bladder disease. The images are accompanied by brief case reports limit 2 typed pages, 4 references. Pneumatosis intestinalis may, however, be indicative of a number of different gastrointestinal disorders or chronic obstructive pulmonary disease.
A condition of unknown cause characterized by the occurrence of gas cysts in the intestinal mucous membrane. The patients information, histories, therapies, courses, and. Pneumatosis cystoides intestinalis a report of two cases. May 11, 2020 benign pneumatosis intestinalis tends to disappear over the course of weeks or months. Because its etiology can vary greatly, management of pi ranges from surgical intervention to outpatient observation see, greenstein et al.
Pneumatosis cystoides intestinalis is a rare disease usually caused by an underlying condition. Pneumatosis cystoides intestinalis medigoo health medical. After these procedures, combining anamnestic, clinical, instrumental and laboratory findings, khalil et al. Pneumatosis intestinalis pi, or the presence of air in the bowel wall, is a rare disorder that is associated with a variety of underlying diseases, including connective tissue disorders. Surgical aspects of pneumatosis cystoides intestinalis. Pneumatosis cystoides intestinalis pci is a rare condition that may be associated with a variety of diseases. The key words were pneumatosis cystoides intestinalis, pneumatosis, pneumatosis intestinalis, pneumatosis coli and mucosal gas. Pneumatosis intestinalis pi is an unusual finding that can exist in a benign setting but can indicate ischemic bowel and the need for surgical intervention. A, scout radiograph from aircontrast barium enema shows cystic pi arrow consistent with pneumatosis cystoides intestinalis. Doctors usually try to identify and treat the underlying cause of the condition to. Pneumatosis cystoides intestinalis associated with sunitinib.
Pdf pneumatosis cystoides intestinalis researchgate. Pdf background pneumatosis cystoides intestinalis pci is a rare selflimiting condition characterized by airfilled cysts within intestinal walls find, read. Pneumatosis cystoides intestinalis with colonic lipomatosis is a rare entity associated with a number of gastrointestinal and systemic disorders. Pneumatosis intestinalis also called intestinal pneumatosis, pneumatosis cystoides intestinalis, pneumatosis coli, or intramural bowel gas is pneumatosis of an intestine, that is, gas cysts in the bowel wall. A 48yearold woman with a prolonged history of glucocorticoid use presented with abdominal. Pi presents on a spectrum from asymptomatic to bowel obstruction and acute abdomen. This section features outstanding photographs of clinical materials selected for their educational value or message, or possibly their rarity. It can be divided into primary or idiopathic 15% type, which refers to air pockets that are. Pneumatosis cystoides intestinalis an incidental finding. Large submucosal pseudocysts lined by macrophages and multinucleated giant cells.
Pneumatosis intestinalis often represents a benign. Indeed, a very disturbing imaging may well be related to a benign pathology. The gross morphology and histological features ofthe specimen were consistent with pneumatosis cystoides intestinalis. It typically presents with multiple gasfilled cysts in the submucosa andor subserosa of the colon. Pneumatosis coli is a descriptive sign presenting radiographically as intramural gas limited to the colonic wall. Pneumatosis cystoides intestinalis subhashbhardwaj,arun gupta ahstjact pneumatosis cystoides intestinalis is a rare condition.
Primary pneumatosis intestinalis is extremely rare. Any information contained in this pdf file is automatically generated from digital material submitted to. Pneumatosis cystoides coli pcc is a rare condition defined as an abnormal location of gas within the colonic wall and regarded as the colonic variant of pneumatosis cystoides intestinalis. Either benign or fulminant form often indolent clinical course, although radiographically can resemble carcinoma patients may have nausea, vomiting, diarrhea. Pneumatosis cystoides intestinalis refers to accumulation of gasfilled cysts within the wall of the intestine, and it may occur at any site in the gi tract. Case report kazuistika pneumatosis cystoides intestinalis. Pneumatosis cystoides intestinalis description, causes and risk factors. Here we demonstrated four different endoscopic manifestations of pci and three cases with intestinal stricture all were successfully managed by medical conservative treatment. The underlying causes of the gas can vary widely and different hypotheses regarding its pathophysiology have been postulated.
It has been identified more frequently in animals, particularly swine fed on dairy refuse. Pdf pneumatosis cystoides intestinalis associated with sunitinib. Pneumatosis intestinalis and bowel perforation associated. In this investigation, gasfilled cysts were produced in the. The underlying causes of the gas found during radiographic studies of the bowel wall can vary widely and different hypotheses regarding its pathophysiology have been postulated. Pi is an ominous condition often requiring emergent surgery. Pneumatosis intestinalis pi refers to the presence of gas within the wall of the small or large intestine. A 17yearold girl with down syndrome and leucopenia due to chemotherapy for acute lymphatic. Intramural gas can also affect the stomach, but thi it seems to us that you have your javascript disabled on your browser. As a radiological sign it is highly suggestive for necrotizing enterocolitis.
Pneumatosis cystoides intestinalis of the ascending colon related to acarbose treatment. Therefore imaging must be comparated with clinical and biological data to eliminate first a lifethreatening emergency. Pneumatosis cystoides intestinalis pci is characterized by gasfilled cysts in. It is a secondary finding caused by a wide variety of underlying gastrointestinal or. In the more frequent secondary forms small intestine and the right side of the colon are mainly affected, and the underlying pathology can be gastrointestinal, pulmonary or. The management can be challenging in some circumstances, as the choice of surgery versus medical treatment can be difficult. Pneumatosis cystoides intestinalis is an unusual condition with gasfilled cysts in the gastrointestinal tract. Cairo baptist hospital, gaza, via egypt pneumatosis or gas cysts ofthe intestines is a rare disease that was first described in man by bang in i876. Complete deflation of a pseudopolypoid lesion after puncture in an attempt to obtain a biopsy led to a diagnosis of pneumatosis cystoides intestinalis gas in the bowel wall. Nov 28, 2011 pneumatosis cystoides intestinalis is a rare condition in which multiple gasfilled cysts are found within the wall of the gastrointestinal tract either in the subserosa or submucosa. Pneumatosis cystoides intestinalis is characterized by the presence of multiple gasfilled cysts in the intestinal wall, the submucosa andor subserosa of the intestine. Pneumatosis cystoides intestinalis pci is a rare disease characterized by the presence of gaseous cysts containing nitrogen, hydrogen and carbon dioxide in the intestinal wall that may be iatrogenic25 or associated with a wide variety of conditions69. Pneumatosis cystoides intestinalis is a rare gastrointestinal condition, in the majority of cases an incidental finding which represents a differential diagnostic challenge for endoscopist, radiologist, pathologist and physician. Moreover, extended information was collected with regard to the nature and pathophysiology of pci, and the incomplete reports were removed.
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. Intramural gas can also affect the stomach, but this condition is referred to as gastric pneumatosis. The hallmark of this condition is the presence of multiple gasfilled cysts along the bowel wall cyrany et al. Definition of pneumatosis cystoides intestinalis in the dictionary.
Oct 25, 2018 pneumatosis intestinalis, defined as gas in the bowel wall, is often first identified on abdominal radiographs or computed tomography ct scans. Pneumatosis cystoides intestinalis, a usually benign entity that consists of intramural air in the intestine, has multiple etiologies and may be seen in sle as a possible result of vasculitis. In pi due to benign causes, the bowel wall is usually normal. It frequently occurs in the setting of an underlying intestinal disease, such as inflammatory bowel disease, neonatal necrotizing enterocolitis, infectious colitis or enteritis, and. Pneumatosis intestinalis is used when only the small bowel wall is involved. This is in contrast to gas in the intestinal lumen which. We present a series of cases of pi in adults to illustrate factors associated with death and surgical intervention.
The size of the cysts may range from a few millimeters. Pneumatosis cystoides intestinalis is a disease occurring rarely in man but identified somewhat more frequently in animals, particularly swine. Pneumatosis cystoides intestinalis endoscopic image. Intramural gas collections in the left colon, in the absence of pneumoperitoneum or other abnormalities, were confirmed by abdominal ct figure c, arrow. In this investigation, gasfilled cysts were produced in the omentum, wound, mesentery, and intestine. It is a radiographic finding and not a diagnosis, as the etiology varies from benign conditions to fulminant gastrointestinal disease. The purpose of this paper is the development of an algorithm for the surgical therapy of pci based one two case reports.
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