pneumatosis cystoides intestinalis

Introduction

Gas in the bowel wall

Etiology

• primary
• secondary (85%)
  • COPD: ruptured pulmonary blebs find their way into the bowel wall
  • gastrointestinal obstruction
    • intestinal obstruction from colorectal carcinoma
    • pyloric stenosis
    • Hirschsprung's disease
  • intestinal necrosis
    • necrotizing enterocolitis
    • mesenteric ischemic disease
    • ingestion of caustic materials
  • immunosuppression
    • organ transplantation
    • AIDS
    • leukemia
  • inflammatory bowel disease
  • gastrointestinal endoscopy
  • mechanical ventilation

Pathology

• numerous gas-containing cysts within the submucosal or subserosal layer of the intestinal wall

Clinical manifestations

• primary form is asymptomatic
• secondary forms consistent with etiology
• case report
  • diffuse abdominal pain, diarrhea, vomiting
  • abdominal distention, diffuse tenderness, guarding

Radiology

• computed tomography of abdomen
  • large amounts of free air
  • extraluminal gas in the wall of the small bowel

Complications

• cyst rupture can produce pneumoperitoneum
• peritonitis

Differential diagnosis

• ischemic bowel

Management

• treatment of underlying etiology
• supportive care
• laparotomy [2[
  • unnecessary to resect bowel in the absence of perforation

More general terms

• lesion