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1.
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.
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
4.
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
5.
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
6.
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
7.
Clin J Gastroenterol ; 13(6): 1165-1172, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32410155

RESUMO

Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gas-filled cysts in the intestinal wall. The majority of patients with PCI are asymptomatic and have a benign clinical course without treatment. Regular colonoscopic follow-up is not always clinically necessary for PCI; therefore, whether all patients with PCI eventually achieve complete endoscopic resolution remains unclear. We herein present the details of an asymptomatic 58-year-old man diagnosed with PCI in the right colon in 2011 by colonoscopy. We followed him using colonoscopy for 8 years without treatment. The PCI lesions gradually changed into multiple flat yellowish plaque-like lesions, and biopsies revealed that these were elastosis, which is a very rare pathological finding in the colon. To our knowledge, only two reports discuss morphological or histological changes similar to those of PCI. Because the development of yellowish plaque-like lesions histologically representing elastosis associated with PCI is an unrecognized entity, we herein discuss its clinical features, endoscopic findings, and histological findings with a literature review.


Assuntos
Pneumatose Cistoide Intestinal , Biópsia , Colo/diagnóstico por imagem , Colonoscópios , Colonoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia
8.
World J Gastroenterol ; 26(14): 1628-1637, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32327911

RESUMO

BACKGROUND: Hepatic portal venous gas (HPVG) generally indicates poor prognoses in patients with serious intestinal damage. Although surgical removal of the damaged portion is effective, some patients can recover with conservative treatments. AIM: To establish an optimal treatment strategy for HPVG, we attempted to generate computed tomography (CT)-based criteria for determining surgical indication, and explored reliable prognostic factors in non-surgical cases. METHODS: Thirty-four cases of HPVG (patients aged 34-99 years) were included. Necessity for surgery had been determined mainly by CT findings (i.e. free-air, embolism, lack of contrast enhancement of the intestinal wall, and intestinal pneumatosis). The clinical data, including treatment outcomes, were analyzed separately for the surgical cases and non-surgical cases. RESULTS: Laparotomy was performed in eight cases (surgical cases). Seven patients (87.5%) survived but one (12.5%) died. In each case, severe intestinal damage was confirmed during surgery, and the necrotic portion, if present, was removed. Non-occlusive mesenteric ischemia was the most common cause (n = 4). Twenty-six cases were treated conservatively (non-surgical cases). Surgical treatments had been required for twelve but were abandoned because of the patients' poor general conditions. Surprisingly, however, three (25%) of the twelve inoperable patients survived. The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments, and only one patient (7%) died. Comparative analyses of the fatal (n = 10) and recovery (n = 16) cases revealed that ascites, peritoneal irritation signs, and shock were significantly more frequent in the fatal cases. The mortality was 90% if two or all of these three clinical findings were detected. CONCLUSION: HPVG related to intestinal necrosis requires surgery, and our CT-based criteria are probably useful to determine the surgical indication. In non-surgical cases, ascites, peritoneal irritation signs and shock were closely associated with poor prognoses, and are applicable as predictors of patients' prognoses.


Assuntos
Ascite/terapia , Embolia Aérea/terapia , Isquemia Mesentérica/terapia , Pneumatose Cistoide Intestinal/terapia , Veia Porta/cirurgia , Choque/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/diagnóstico , Ascite/etiologia , Ascite/mortalidade , Tratamento Conservador/estatística & dados numéricos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Embolia Aérea/mortalidade , Feminino , Gases , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia , Masculino , Isquemia Mesentérica/complicações , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/mortalidade , Necrose/complicações , Necrose/diagnóstico , Necrose/mortalidade , Necrose/cirurgia , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/mortalidade , Veia Porta/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Choque/diagnóstico , Choque/etiologia , Choque/mortalidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Transplant Proc ; 52(3): 938-942, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32122661

RESUMO

BACKGROUND: Pneumatosis intestinalis (PI) is a rare pathologic finding in pediatric liver transplant (PLT) recipients. The presentation and course of PI can range from asymptomatic and clinically benign to life threatening, with no consensus regarding management of PI in children. We aim to review the clinical presentation and radiologic features of PLT recipients with PI and to report the results of conservative management. METHODS: A retrospective medical chart review was conducted on PLT recipients between November 1995 and May 2016. Parameters evaluated at PI diagnosis included pneumatosis location, presence of free air or portal venous gas (PVG), symptoms, laboratory findings, and medication regimen. RESULTS: PI developed in 10 of 130 PLT patients (7.7%) between 8 days and 7 years (median: 113 days) posttransplant. Five of the patients were male, and the median age was 2 years (range, 1-17 years). PI was located in 1 to 2 abdominal quadrants in 6 patients, and 3 patients had PVG. At diagnosis, all patients were on steroids and immunosuppressant medication and 6 patients had a concurrent infection. Laboratory findings were unremarkable. Symptoms were present in 7 patients. Nine patients were managed conservatively, and 1 patient received observation only. All patients had resolution of PI at a median of 7 days (range, 2-14 days). CONCLUSIONS: PI can occur at any time after PLT and appears to be associated with steroid use and infectious agents. If PI/PVG is identified and the patient is clinically stable, initiation of a standard management algorithm may help treat these patients conservatively, thus avoiding surgical intervention.


Assuntos
Transplante de Fígado/efeitos adversos , Pneumatose Cistoide Intestinal/etiologia , Pneumatose Cistoide Intestinal/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Adolescente , Algoritmos , Criança , Pré-Escolar , Tratamento Conservador/métodos , Feminino , Humanos , Lactente , Masculino , Veia Porta , Estudos Retrospectivos
10.
J. coloproctol. (Rio J., Impr.) ; 40(1): 94-97, Jan.-Mar. 2020. ilus
Artigo em Inglês | LILACS | ID: biblio-1090834

RESUMO

Abstract Pneumatosis cystoides intestinalis is an uncommon disease with unknown etiology characterized by the presence of multiple gas-filled cysts within the submucosa or subserosa of the intestinal wall. Pneumoperitoneum and/or intestinal perforation are complications that may be associated with pneumatosis cystoides intestinalis. The patients are often prone to misdiagnosis or mistreatment.We are presenting a case of pneumatosis cystoides intestinalis in a 42 year-old woman affected by peritoneal free air and numerous, diffuse, bubble-like intramural gas collections into the jejunum and ileum, showed in CT-enterography images. The woman had a carcinoid tumor located in jejunum two years ago, treated with enterectomy. Recent complaints of nonspecific symptoms of abdominal discomfort and diarrhea motivated the realization of CT scan, serum chromogranin and urine 5-hidroxindolacetic acid for hypothesis of tumor carcinoid recurrence withdraw. The only change found was the presence of pneumatosis cystoides intestinalis in CT-enterography images without intestinal necrosis, bleeding or evident obstruction. For that reason no surgical procedure was realized and the patient stayed on surveillance. Actually, the patient complaints are sporadic abdominal discomfort, without pneumatosis cystoides intestinalis clinical evidence. Conclusion: The treatment plan of patient with PCI depends on underlying cause and clinical condition severity. When conservative treatment is adopted the clinical evolution of pneumatosis cystoides intestinalis is unpredictable and can even disappear in an indeterminate number of patients.


Resumo A pneumatose cistoide intestinal é uma doença incomum, de etiologia desconhecida, caracterizada pela presença de múltiplos cistos preenchidos com gás na submucosa ou subserosa da parede intestinal. O pneumoperitoneu e/ou a perfuração intestinal são complicações que podem estar associadas à pneumatose cistoide intestinal. Os pacientes geralmente estão sujeitos a erros de diagnóstico ou de tratamento.Apresentamos um caso de pneumatose cistoide intestinal em paciente do sexo feminino, 42 anos de idade, com ar livre peritoneal e numerosas coleções gasosas intramurais, difusas e semelhantes a bolhas no jejuno e íleo, visualizados em imagens de enterografia por tomografia computadorizada (TC). Há dois anos, a paciente teve um tumor carcinoide localizado no jejuno que foi tratado com enterectomia. As queixas recentes de sintomas inespecíficos, desconforto abdominal e diarreia motivaram a realização da TC e exame de cromogranina sérica e ácido 5-hidroxindolacético na urina para excluir a hipótese de recorrência do tumor carcinoide. A única alteração encontrada foi a presença de pneumatose cistoide intestinal em imagens de enterografia por TC sem necrose intestinal, sangramento ou obstrução evidente. Por esse motivo, nenhum procedimento cirúrgico foi realizado, e a paciente permaneceu em observação. Atualmente, a queixa da paciente é de desconforto abdominal esporádico, sem evidência clínica de pneumatose cistoide intestinal. Conclusão: O plano de tratamento de pacientes com PCI depende da causa subjacente e da gravidade da condição clínica. Quando o tratamento conservador é adotado, a evolução clínica da pneumatose cistoide intestinal é imprevisível e pode até desaparecer em alguns pacientes.


Assuntos
Humanos , Feminino , Adulto , Pneumatose Cistoide Intestinal , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/terapia
13.
Dig Dis Sci ; 64(10): 2769-2775, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31410751

RESUMO

INTRODUCTION: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the small and large intestines. We describe a case of a 70-year-old man admitted to the Emergency Surgery Department for PCI who was treated conservatively. AREAS COVERED: We reviewed 60 cases of PCI described in the international literature over the last 5 years. From our analysis, it appears that the etiology of the gas production within the submucosa or the subserosa of the gastrointestinal tract is still unknown. The rupture of the cysts can lead to pneumoperitoneum that can simulate a surgical emergency. EXPERT COMMENTARY: For patients with PCI, a conservative approach is the treatment of choice, with surgery mandatory only for complicated disease.


Assuntos
Abdome Agudo/diagnóstico , Tratamento Conservador/métodos , Pneumatose Cistoide Intestinal , Pneumoperitônio , Tomografia Computadorizada por Raios X/métodos , Idoso , Colonoscopia/métodos , Diagnóstico Diferencial , Humanos , Masculino , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/fisiopatologia , Pneumatose Cistoide Intestinal/terapia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Radiografia Abdominal/métodos , Resultado do Tratamento , Procedimentos Desnecessários
18.
Rev Fac Cien Med Univ Nac Cordoba ; 75(3): 205-211, 2018 09 22.
Artigo em Espanhol | MEDLINE | ID: mdl-30296029

RESUMO

Objective: To present a recent to increase understanding, diagnosis and treatment of intestinal pneumatosis clinical case, considering the distinctive characteristics of the disease and to expand knowledge about the management of this condition. Methods: The case of a female patient aged 65, originally from Bolivia, with a history of osteoarthritis, osteoporosis, asthma and allergies repetition occurs. The patient was admitted to the Department of Surgery No. 1 HNC in November 2015, with an unclear clinical picture. During admission of air bubbles present in the colonic mucosa and tumor lesion is discovered duodenum. Quickly it begins with treatment and adequate support for stabilization. A literature search and an update of the latest updates regarding this disease arises. medical seekers popularity as PUBMED, UP TO DATE, VBS were used. a series of articles about it were selected. The patient cited in this work has given us the corresponding written consent for the anonymous publication with scientific purposes about her information. Also we declare the absence of external financing and conflicts of interest. Conclusions: it was concluded that management should generally be conservative, excluding the case of complications (obstruction, perforation) and suspected intestinal ischemia. Exploratory laparoscopy may be helpful to determine the appropriate behavior. Conservative treatment includes antibiotics, hyperbaric oxygen and supportive measures.


Assuntos
Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/terapia , Idoso , Colonoscopia , Evolução Fatal , Feminino , Humanos , Tomografia Computadorizada por Raios X
20.
BMJ Case Rep ; 20182018 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-30002210

RESUMO

We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.


Assuntos
Anti-Infecciosos/uso terapêutico , Alimentos Formulados , Oxigenoterapia/métodos , Pneumatose Cistoide Intestinal/terapia , Pneumoperitônio/terapia , Escleroderma Sistêmico/complicações , Idoso , Terapia Combinada , Feminino , Humanos , Pneumatose Cistoide Intestinal/etiologia , Pneumoperitônio/etiologia
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