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1.
BMJ Case Rep ; 14(11)2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772675

RESUMO

Pneumatosis intestinalis is described as gas within the bowel wall and can be a sign of bowel ischaemia with a pending perforation. The described patient presented with the incidental diagnosis of pneumatosis intestinalis with free intraperitoneal gas on CT scan. His medical history included a successful lung transplantation. We here describe the clinical decision-making and evaluate our case with previous cases in the literature.


Assuntos
Transplante de Pulmão , Isquemia Mesentérica , Pneumatose Cistoide Intestinal , Humanos , Intestinos , Transplante de Pulmão/efeitos adversos , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Tomografia Computadorizada por Raios X
2.
Ann Ital Chir ; 102021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34694239

RESUMO

MATERIALS AND METHODS: We present here the case of an 83 y.o. male with intestinal perforation from pneumatosis cystoides intestinalis and consequent sepsis. RESULTS: The patient underwent urgency intestinal resection in our institute, with complete restitution ad integrum Discussion: Pneumatosis cystoides intestinalis is a rare affection, which can be categorized as primary (15%) or idiopathic( 85%). The clinical appearance can be very variable from patient to patient, since it can be completely asymptomatic or start with life-threatening clinical presentation of bowel perforation and sepsis. There are various theories about the formation of the gas bubbles trough the intestinal wall. The mechanical theory assumes that the gas, tearing trough the intestinal wall seeps trough it. The bacterial theory assumes that antibiotic treatment, such as with metronidazole, allows the creation of gas by microbiological elements like Clostridium Perfringens or Clostridium Difficile. The pulmonary theory, instead, assumes that air released from ruptured alveoli gets into the mediastinum and retro peritoneum, reaching the intestinal tract. The treatment is conservative most of the times, except for the cases of intestinal perforation and sepsis. CONCLUSIONS: Despite of the long history of the disease, with the first description in 1783, little is known nowadays about PCI, due to the rarity of symptomatic disease. Further studies are needed to better evaluate the aetiology of the condition, and the prognostic criteria, which may be very important for clinical decisions about conservative or surgical treatment. KEY WORDS: Diagnosis, Pneumatosis cystoides intestinalis, Peritonitis, Therapy.


Assuntos
Perfuração Intestinal , Intervenção Coronária Percutânea , Pneumatose Cistoide Intestinal , Sepse , Humanos , Perfuração Intestinal/etiologia , Intestinos , Masculino , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia , Sepse/complicações
3.
J Pediatr Gastroenterol Nutr ; 73(4): e87-e93, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183613

RESUMO

INTRODUCTION: Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI. METHODS: This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P < 0.05. RESULTS: Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114). CONCLUSION: Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.


Assuntos
Pneumatose Cistoide Intestinal , Estudos de Casos e Controles , Criança , Humanos , Intestino Delgado , Intestinos , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Estudos Retrospectivos
4.
BMJ Case Rep ; 14(4)2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888480

RESUMO

This case demonstrates pneumatosis intestinalis and small bowel perforation in a paediatric patient with multisystem inflammatory syndrome in children (MIS-C). Our patient presented with fever, abdominal pain and shortness of breath. She progressed to haemodynamic failure and small bowel perforation approximately 1 week after admission. Patients with suspected or confirmed MIS-C should be monitored closely for abdominal catastrophe, especially when critically ill in the intensive care unit.


Assuntos
Perfuração Intestinal , Pneumatose Cistoide Intestinal , Síndrome de Resposta Inflamatória Sistêmica/complicações , Criança , Feminino , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia
5.
Transplant Proc ; 53(4): 1215-1218, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33678444

RESUMO

BACKGROUND: Pneumatosis intestinalis (PI) is a rare condition usually occurring among adults who have undergone solid organ transplant and are taking steroid therapy. The coronavirus disease 2019 (COVID-19) virus uses angiotensin-converting enzyme 2 in gastrointestinal epithelium as a receptor for entry process. Due to the steroid intake, the COVID-19 virus is present in the patient's gastrointestinal tract for extended period of time. It may therefore increase the possibility of PI in such patients. It is usually asymptomatic, with a clinical spectrum ranging from indolent to life-threatening. Unfortunately, there are no algorithms concerning diagnosis and treatment of PI. AIM OF STUDY: The aim of this study is to highlight the problem of PI induced by COVID-19, especially in high-risk groups such as solid organs recipients. CONCLUSION: On the basis of the presented case of a severe course of COVID-19-induced PI, we conclude that laparotomy with bowel resection can be a feasible and a safe option for treatment.


Assuntos
COVID-19/diagnóstico , Transplante de Rim , Pneumatose Cistoide Intestinal/diagnóstico , Adulto , COVID-19/complicações , COVID-19/virologia , Colo/diagnóstico por imagem , Humanos , Laparotomia , Masculino , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/cirurgia , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X
6.
Transplant Proc ; 53(4): 1379-1381, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33712306

RESUMO

INTRODUCTION: Pneumatosis intestinalis (PI) is a rare but critical condition in which gas is found in the bowel wall. Although organ transplant recipients have an increased PI risk because of long-term immunosuppression, alpha-glucosidase inhibitors (α-GI), a standard diabetes therapy, often contribute to PI. However, little is known about the postorgan transplantation relationship between PI and α-GI. To the best of our knowledge, this is the first reported case of PI in a lung transplant recipient treated with α-GI. CASE REPORT: A 59-year-old man underwent hybrid (living-donor and cadaveric) lung transplantation (LTx). The patient was treated with prednisolone and tacrolimus as immunosuppressive therapy and α-GI for diabetes for 4 years. He developed asymptomatic PI 1031 days after transplantation without any acute abdominal finding. After excluding other possible causes of PI, his PI was attributed to α-GI. The suspected α-GI was immediately withdrawn. The patient was managed conservatively with bowel rest and oxygen therapy. After 11 days of α-GI discontinuation, PI improved, and the patient completely recovered. CONCLUSION: Physicians should keep this rare adverse drug reaction in mind when prescribing α-GI, particularly in patients with diabetes after organ transplantation and including LTx. The management strategy for asymptomatic PI caused by α-GI is the immediate discontinuation of α-GI therapy, followed by conservative management initiation.


Assuntos
Inibidores de Glicosídeo Hidrolases/efeitos adversos , Pneumatose Cistoide Intestinal/etiologia , Abdome/diagnóstico por imagem , Cadáver , Inibidores de Glicosídeo Hidrolases/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Doadores Vivos , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico , Tomografia Computadorizada por Raios X
7.
J Pediatr Surg ; 56(11): 2073-2077, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33455803

RESUMO

BACKGROUND/PURPOSE: Pneumatosis intestinalis (PI) has been reported in hematopoietic stem cell transplant recipients (HSCT) since 1980s and at present there is no uniform consensus of the significance and management of this condition. METHODS: We retrospectively reviewed medical records of 990 consecutive pediatric HSCT recipients and examined data for clinical PI presentation, management and outcomes RESULTS: PI was identified in 53 patients (5.4%), mainly allogeneic HSCT recipients receiving systemic steroids. Abdominal X-ray was the main diagnostic modality. Forty-seven patients (89%) were evaluated because of clinical concerns and others were identified as incidental findings. Pneumoperitoneum was reported in 15 patients (28%). None of these patients had signs of acute abdomen. The majority of patients (43/53, 81%) had no targeted clinical intervention for PI and resolved PI in a median of 15 days (IQR 3-61). Surgery consult was only requested for 7/53 (13%) patients, three of whom had evidence of pneumoperitoneum. None of these patients required any surgical interventions. CONCLUSIONS: Pneumatosis intestinalis commonly occurs in HSCT recipient receiving steroids, but unlike with NEC, PI rarely poses clinical risk after transplant. The majority of HSCT recipients with PI require only close monitoring without interventions. Surgical evaluation should be based on clinical symptoms and not PI presence alone.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Pneumatose Cistoide Intestinal , Pneumoperitônio , Criança , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Radiografia Abdominal , Estudos Retrospectivos
8.
J Trauma Acute Care Surg ; 90(3): 477-483, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33075028

RESUMO

BACKGROUND: The significance of pneumatosis intestinalis (PI) remains challenging. While certain clinical scenarios are predictive of transmural ischemia, risk models to assess the presence of pathologic PI are needed. The aim of this study was to determine what patient factors at the time of radiographic diagnosis of PI predict the risk for pathologic PI. METHODS: We conducted a retrospective cohort study examining patients with PI from 2010 to 2016 at a multicenter hospital network. Multivariate logistic regression was used to develop a predictive model for pathologic PI in a derivation cohort. Using regression-coefficient-based methods, the final multivariate model was converted into a five-factor-based score. Calibration and discrimination of the score were then assessed in a validation cohort. RESULTS: Of 305 patients analyzed, 102 (33.4%) had pathologic PI. We identified five factors associated with pathologic PI at the time of radiographic diagnosis: small bowel PI, age 70 years or older, heart rate 110 bpm or greater, lactate of 2 mmol/L or greater, and neutrophil-lymphocyte ratio 10 or greater. Using this model, patients in the validation cohort were assigned risk scores ranging from 0 to 11. Low-risk patients were categorized when scores are 0 to 4; intermediate, score of 5 to 6; high, score of 7 to 8; and very high risk, 9+. In the validation cohort, very high-risk patients (n = 17; 18.1%) had predicted rates of pathologic pneumatosis of 88.9% and an observed rate of 82.4%. In contrast, patients labeled as low risk (n = 37; 39.4%) had expected rates of pathologic pneumatosis of 1.3% and an observed rate of 0%. The model showed excellent discrimination (area under the curve, 0.90) and good calibration (Hosmer-Lemeshow goodness-of-fit, p = 0.37). CONCLUSION: Our score accurately stratifies patient risk of pathologic pneumatosis. This score has the potential to target high-risk individuals for expedient operation and spare low-risk individuals invasive interventions. LEVEL OF EVIDENCE: Prognostic Study, Level III.


Assuntos
Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/etiologia , Idoso , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(11): 1113-1116, 2020 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-33212565

RESUMO

Pneumatosis cystoides intestinalis (PCI) is a rare disease, which is characterized by the accumulation of gas cysts located in the submucosa or subserosa of the gastrointestinal tract. It can occur in the whole or part of the gastrointestinal tract from the esophagus to the rectum, but clinically the main involved sites are the colon and small intestine. PCI can also appear in other sites such as mesentery, the greater omentum and the hepatogastric ligament. In recent years, with the renewal of imaging method, the detection rate of PCI has been on the rise. Most patients with PCI have no obvious symptoms or only non-specific symptoms of the digestive tract like abdominal distension, abdominal pain, diarrhea, hematochezia, etc. The atypical clinical symptoms of PCI can easily lead to missed diagnosis or misdiagnosis. A small amount of patients would have complications like peritonitis and even perforation of the digestive tract. The therapeutic principle for these patients is different from that for patients with acute abdomen. The prognosis of PCI depends on its severity and comorbidities. In this article, a literature review would be conducted on the epidemiological characteristics, etiology and pathogenesis, clinical manifestations, diagnosis and treatment of PCI, which might help clinical doctors with diagnosis and treatment of the disease.


Assuntos
Pneumatose Cistoide Intestinal , Humanos , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/epidemiologia , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia
14.
Rev Gastroenterol Peru ; 40(2): 188-192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876638

RESUMO

Pneumatosis intestinalis (PI) is defined as presence of gas within the intestinal wall. It is a rare condition, usually associated with a wide variety of pathologies. It requires a special diagnostic approach to determine underlying etiology. We present the case of a 18 year old woman with chronic abdominal pain, who presents with peritoneal signs and pneumoperitoneum. Laparoscopy showed NI. Thereafter, Crohn´s disease was diagnosed by balloon enteroscopy.


Assuntos
Doença de Crohn/complicações , Pneumatose Cistoide Intestinal/etiologia , Adolescente , Doença de Crohn/diagnóstico , Feminino , Humanos
16.
Clin J Gastroenterol ; 13(6): 1160-1164, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32794155

RESUMO

Enteral nutrition is usually associated with a low risk of intestinal complications. We report three non-critically ill patients who received enteral nutrition and developed mesenteric ischemia with pneumatosis intestinalis and hepatic portal vein gas. These findings are often considered to be indications for emergency surgery. In these three patients, prompt cessation of enteral nutrition avoided progression to intestinal necrosis obviating the need for intestinal resection, although one patient underwent surgical exploration. Follow-up computed tomography scan showed resolution of the radiologic findings, and all patients started enteral nutrition again without complications. All patients had comorbidities associated with atherosclerosis, which may have led to a mismatch between oxygen delivery and demand in the bowel, resulting in ischemia. To the best of our knowledge, this is the first report of successful management of mesenteric ischemia related to enteral nutrition in non-critically ill patients without resection. If the cause of mesenteric ischemia such as enteral nutrition, can be eliminated quickly, non-resectional and possibly nonoperative management can be a reasonable management option, with close follow-up and readiness for resection.


Assuntos
Isquemia Mesentérica , Pneumatose Cistoide Intestinal , Nutrição Enteral/efeitos adversos , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/etiologia , Isquemia Mesentérica/cirurgia , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia , Veia Porta/diagnóstico por imagem
17.
Rev Esp Enferm Dig ; 112(8): 661, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32496113

RESUMO

Intestinal pneumatosis is a radiologic finding that consists of the presence of air in the intestinal wall. The etiology is extensive and can range from a benign entity to one that compromises the patients´ life. It is important to know and recognize the differences between them as the surgical management will depend on it. We report the case of an 82-year-old male diagnosed with a metastatic castration resistant prostate carcinoma, under chemotherapy with disease progression in treatment with high doses of intravenous morphics. The patient reported abdominal distension with constipation and no vomiting in the emergency department and a distended and tympanic abdomen, without generalized peritonitis was identified during physical examination. A blood analysis showed lactate levels of 0.9 mmol/L and a PCR of 4.2 mg/L without leukocytosis. An extensive colonic pneumatosis with minimum pneumoperitoneum without free fluid was confirmed by a computed tomography (CT) scan (Fig 1). A conservative approach with intravenous antibiotic and clinical surveillance was decided due to the fact that the patient was clinically stable without generalized peritonitis nor pathological findings in the supplementary blood tests. The clinical evolution was uneventful and the patient was discharged from hospital De la Serna et al. opted for a conservative approach for a patient with stage IV lung adenocarcinoma under chemotherapy treatment, who presented asymptomatic intestinal pneumatosis and subsequently made a full recovery. We also believe that the use of some chemotherapeutic agents may cause an increase in the permeability of the intestinal capillaries, allowing air to flow into the intestinal walls. Thus, resulting in this radiologic image, which is more a radiological finding than a disease. We think that a conservative initial attitude should be recommended in hemodynamically stable cases, without peritonitis and non-pathological blood analysis.


Assuntos
Peritonite , Pneumatose Cistoide Intestinal , Pneumoperitônio , Idoso de 80 Anos ou mais , Colo , Humanos , Masculino , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia , Tomografia Computadorizada por Raios X
19.
Rev Esp Enferm Dig ; 112(7): 575-576, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32579008

RESUMO

The association of intestinal and portal pneumatosis in the same patient usually occurs in intestinal ischemic-necrotic processes, with ominous prognosis. However, there are forms of presentation outside this context, with a radically different management and evolution. We present the case of a patient with portal and gastric pneumatosis, managed conservatively successfully. The clinical presentation and a multidisciplinary management will be critical in the decision-making process to obtain favorable results.


Assuntos
Pneumatose Cistoide Intestinal , Humanos , Intestinos , Necrose , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia , Veia Porta/diagnóstico por imagem , Prognóstico
20.
Emerg Radiol ; 27(5): 547-553, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32363503

RESUMO

Gastrointestinal pneumatosis has been reported from the esophagus to the rectum, with most cases involving the small bowel, stomach, or colon. Esophageal pneumatosis is rare, with only a small number of case reports described in the literature, although it is likely underreported. Esophageal pneumatosis may be idiopathic or secondary to a specific underlying cause. Mechanisms of esophageal pneumatosis include increased intraluminal pressure, mucosal disruption, and dissection of air from an extraesophageal source. Depending on the underlying cause, esophageal pneumatosis is usually benign although it may be indicative of a life threatening condition. Esophageal pneumatosis is typically detected with CT, although it may be evident during direct visualization with endoscopy. In this article, we review the etiologies and imaging appearances of esophageal pneumatosis.


Assuntos
Doenças do Esôfago/diagnóstico por imagem , Esofagoscopia , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/fisiopatologia
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