pneumatosis cystoides intestinalis
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Introduction
Gas in the bowel wall
Etiology
- primary
- secondary (85%)
- COPD: ruptured pulmonary blebs find their way into the bowel wall
- gastrointestinal obstruction
- intestinal necrosis
- necrotizing enterocolitis
- mesenteric ischemic disease
- ingestion of caustic materials
- immunosuppression
- inflammatory bowel disease[1]
- gastrointestinal endoscopy[1]
- mechanical ventilation[1]
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[2]
- diffuse abdominal pain, diarrhea, vomiting
- abdominal distension, diffuse tenderness, guarding
Radiology
- computed tomography of abdomen[1][2]
- large amounts of free air
- extraluminal gas in the wall of the small bowel
Complications
- cyst rupture can produce pneumoperitoneum[2]
- peritonitis
Differential diagnosis
Management
- treatment of underlying etiology
- supportive care
- laparotomy [2[
- unnecessary to resect bowel in the absence of perforation[2]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Wu SS and Yen HH Images in Clinical Medicine: Pneumatosis Cystoides Intestinalis N Engl J Med 2011; 365:e16August 25, 2011 http://www.nejm.org/doi/full/10.1056/NEJMicm1013439
Sugihara Y, Okada H. Images in Clinical Medicine: Pneumatosis Cystoides Intestinalis N Engl J Med 2017; 377:2266. December 7, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29211667 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1701357 - ↑ 2.0 2.1 2.2 2.3 2.4 Pata F, Di Saverio S. Pneumatosis Cystoides Intestinalis with Pneumoperitoneum. N Engl J Med 2019; 380:e17, March 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30917262 Free full text https://www.nejm.org/doi/full/10.1056/NEJMicm1808960
- ↑ Pneumatosis Cystoides Intestinalis Primary Pneumatosis Intestinalis http://www.learningradiology.com/archives2009/COW%20347-Pneumatosis%20Cystoides%20Int/pneumatosiscorrect.htm