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Category: Volume 09 Issue 04 April 2021
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Title: Pneumatosis Cystoides Intestinalis: A Report of 2 Cases

Authors: Dr Anchana Gulati, Dr Shobha Mohindroo, Dr Ishant Sharma, Dr Shikha Sharma

 DOI: https://dx.doi.org/10.18535/jmscr/v9i4.06

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare condi­tion, associated with a variety of diseases. The presenting clinical picture is usually variable and represents a diagnostic challenge for the clinician. In the present paper we describe PCI, its common and an uncommon clinical presentation and pathological findings. Ours is a case report of 2 cases, both of which presented in a different clinical setting confirming that, apart from asymptomatic cases, the clinical presentation of PCI may be widely different. Our findings also point out that clinicians and endoscopists should be aware of the possible presentations of PCI in order to correctly manage the patients with PCI and avoid unnecessary surgeries.

References

  1. Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA. Pneumatosis intestinalis: a review. Am J Gastroenterol. 1995;90: 1747–58.
  2. Read NW, Al-Janabi MN, Cann PA. Is raised breath hydrogen related to the pathogenesis of pneumatosis coli? Gut 1984; 25: 839-845
  3. Koss LG. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis); an analysis with a report of a case and a critical review of the literature.AMA Arch Pathol.1952; 53(6):523– 49.
  4. McCollister DL, Hammerman HJ. Air, air, everywhere: pneu­matosis cystoides coli after colonoscopy. Gastrointes Endosc 1990; 36: 75-76
  5. Wandtke J, Skucas J, Spataro R, Bruneau RJ. Pneumatosis intestinalis as a complication of jejunoileal bypass. AJR Am J Roentgenol 1977; 129: 601-604.
  6. Gagliardi G, Thompson IW, Hershman MJ, Forbes A, Haw­ley PR, Talbot IC. Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis 1996; 11: 111-118.
  7. Sequeira W. Pneumatosis cystoides intestinalis in systemic sclerosis and other diseases. Semin Arthritis Rheum 1990; 19: 269- 277.
  8. Duncan B, Barton LL, Eicher ML, Chmielarczyk VT, Erdman SH, Hulett RL. Medication-induced pneumatosis intestinalis. Pediatrics 1997; 99: 633-636.
  9. Zimmerman AL, Gupta JK, Ingegno AP. Pneumatosis coli following treatment with lactulose. N Y State J Med 1979; 79:1896-1899.
  10. Wu L-L, Yang Y-S, Dou Y, Liu Q-S. A systemic analysis of Pneumatosis cystoids intestinalis. World J Gastroenterol.2013;19 (August (30)):4973–8.
  11. Wu L-L, Yang Y-S, Dou Y, Liu Q-S. A systemic analysis of pneumatosis cystoids intestinalis. World J Gastroenterol. 2013;19(August (30)):4973–8.
  12. Khail PN, Huber-Wagner S, Ladurner R, Kleespies A, Siebeck M, Mutschler W,Halfeldt K, Kanz KG. Natural history, clinical pattern, and surgical consideration of pneumatosis interstialis. Eur J Med  2009;14(6):231–9.
  13. Kanchela D, Vattikuti S, Vipperla K. Pnematosis cystoides intestinalis: is surgery always indicated? Cleve Clin J Med.2015;82(3):151–2.
  14. Ogul H, Pirimoglu B, Kisaoglu A, Karaca L, Havan N, Ozogul B, Kantarci M. Pneumatosis cystoides intestinalis: an unusual cause of intestinal ischemia and pneumoperitoneum. Int Surg. 2015; 100(2): 221–4.
  15. DuBose JJ, Lissauer M, Maung AA, Piper GL, O'Callaghan TA, Luo-Owen X,Inaba K, Okoye O, Shestopalov A, Fielder WD, Ferrada P, Wilson A, Channel J,Moore FO, Paul DB, Johnson S. Pneumatosis intestinalis predictive evaluation study (PIPES):a multicenter epidemiologic study of the eastern association for the surgery of trauma. J Trauma Acute Care Surg. 2013;75(1):15–23.
  16. Xianyong Gui, Yi Zhou, Leslie Eidus, Vincent Falck, Zu-hua Gao, And Lihui Qin (2014) Is Pneumatosis Cystoides Intestinalis Gas-Distended and Ruptured Lymphatics?: Reappraisal by Immunohistochemistry. Archives of Pathology & Laboratory Medicine: August 2014, Vol. 138,No. 8, pp. 1059-1066.
  17. Galandiuk S, Fazio VW. Pneumatosis cystoides intestinalis. A review of the literature. Dis Colon Rectum 1986; 29: 358-363.
  18. Heer M, Altorfer J, Pirovino M, Schmid M. Pneumatosis cystoides coli: a rare complication of colonoscopy. Endoscopy 1983; 15: 119-  
  19. Gillon J, Tadesse K, Logan RF, Holt S, Sircus W. Breath hydrogen in pneumatosis cystoides intestinalis. Gut 1979; 20: 1008- 1011.
  20. St Peter SD, Abbas MA, Kelly KA. The spectrum of pneuma­tosis Arch Surg 2003; 138: 68-75.
  21. Galandiuk S, Fazio VW. Pneumatosis cystoides intestinalis: a review of the literature. Dis Colon Rectum 1986;29: 358–363.
  22. Heng Y, Schuffler MD, Haggitt RC, et al. Pneumatosis intestinalis: a review. Am J Gastroenterol 1995;90:1747–1758.
  23. Koreishi A, Lauwers GY, Misdraji J. Pneumatosis intestinalis: a changing biopsy diagnosis. Am J Surg Pathol 2007;31:1469–1475.
  24. Rottenstreich A, Agmon Y, Elazary R. A rare case of benign Pneumatosis intestinalis with portal venous gas and pneumoperitoneum induced by Acarbose. Intern Med.2015;54:1733–6.
  25. Yanaru R, Hizawa K, Nakamura S, et al. Regression of pneumatosis cystoides intestinalis after discontinuing of alpha- glucosidase inhibitor administration.J Clin Gastroenterol 2002;35:204–5.
  26. Tsujimoto T, Shioyama E, Moriya K. Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: a case report and review of the literature. World J Gastroenterol. 2008;14(39):6087–92.
  27. Feuerstein JD, White N, Berzin TM. Pneumatosis intestinalis with a focus on hyperbaric oxygen therapy. Mayo Clin Proc. 2014;89:697– 703.
  28. Masterson JS, Fratkin LB, Osler TR, Trapp WG. Treatment of pneumatosis cystoides intestinalis with hyperbaric oxygen. Ann Surg. 1978;187:245–7.

Corresponding Author

Dr Shikha Sharma

Senior Resident, Pathology Department, IGMC Shimla