Journal List > Korean J Gastroenterol > v.67(5) > 1007510

Kim, Kim, Kwon, Jang, Jung, Seong, Cheung, and Park: Clinical Course of Three Cases of Pneumatosis Intestinalis

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. PCI may idiopathic or secondary to various disorders. The etiology and pathogenesis of PCI are unclear. Treatment is usually conservative, and includes oxygen and antibiotics therapy. Surgery is reserved for cases of suspected inconvertible intestinal obstruction or perforation. Eleven patients who were diagnosed with PI between 2005 and 2015 were reviewed. We report three cases of PCI and describe causes and complications. The most important point in the treatment of PCI is to determine whether the patient needs surgery. Conservative care should be considered first if the patient is stable. If any complication is observed, such as ischemia in the intestine, surgery is needed. It is important to choose the best treatment based on prognostic factors and CT findings.

References

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Fig. 1.
Contrast enhanced CT scan shows intramural bubble gas-like pneumatosis intestinalis (arrow) in the small bowel (case 1).
kjg-67-262f1.tif
Fig. 2.
Colonoscopic findings show several polypoid mucosal elevations of variable size, and demarcated erythematous friable mucosal changes at distal descending colon (case 1).
kjg-67-262f2.tif
Fig. 3.
Contrast enhanced CT scan shows intramural linear gas-like pneumatosis intestinalis in the small bowel (case 2).
kjg-67-262f3.tif
Fig. 4.
Contrast enhanced CT scan shows large amount of gas in the intrahepatic portal vein (case 2).
kjg-67-262f4.tif
Table 1.
Clinical Characteristics of the 11 Patients with Pneumatosis Cystoides Intestinalis
Variable Data
Sex (male/female) 5/6
Age (yr) 45.7 (0–82)
Main symptom  
 Abdomen pain 8
 Abdomen bloating 2
 Diarrhea 2
 Symptom free 1
Diagnostic method  
 Abdominal CT 7
 Abdominal sonography 2
 Colonoscopy 1
 Biopsy 1
Associated conditions  
 Ischemic bowel disease 2
 Necrotizing enterocolitis 2
 Ileus 1
 Graft versus host disease 1
 Diabetic ketoacidosis 1
 Systemic sclerosis 1
 COPD 1
 Post EMR 1
 No associated condition 1
Site of cyst  
 Small bowel 5
 Large bowel 5
 Large bowel+retroperitoneum 1
 Gas in portal or mesenteric vein 4
Gas pattern  
 Bubble type 2
 Linear type 4
 Bubble and linear type 1
Treatment  
 Antibiotics+conservative 11
Mortality rate 3 (27.2)

Values are presented as n only, mean (range), or n (%).

COPD, chronic obstructive pulmonary disease; EMR, endoscopic mucosal resection.

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