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Pneumatosis Cystoides Intestinalis and Pneumoperitoneum



Related narrative: Pneumatosis Cystoides Intestinalis and Pneumoperitoneum

Pneumatosis cystoides intestinalis (PCI), first described in 1730 by Du Veroni, is usually an asymptomatic, incidental finding on X-ray or CT scan. It appears as bleb-like cysts of the serosa or submucosa, rarely in the muscularis, and may be segmental or localized. It may be primary, with no associated pathologic condition, or secondary. Symptoms sometimes associated with the primary form include diarrhea, mucous rectal discharge, hematochezia, pain, constipation and distention. Men and women are equally affected, and it is usually seen between ages 40-70. It is sometimes associated with obstructive pulmonary disease and immunocompromised states. Most of the time the condition resolves spontaneously and requires no treatment. Non-surgical bowel wall gas may also be induced by endoscopic procedures. In about 3% of cases, PCI is complicated by volvulus, obstruction, intussusception, hemorrhage, intestinal perforation or pneumoperitoneum.

There is considerable confusion in the classification of bowel-wall gas in the texts and literature. Pathological bowel-wall gas is usually infectious in nature and is seen with dead bowel, as in toxic megacolon and pediatric necrotizing enterocolitis (NEC). The most common organisms are e-coli, klebsiella and clostridium. The pattern of gas is distinct from PCI in that it is thin, streaky and interstitial. These patients are severely toxic and symptomatic in contrast to PCI.

Pneumoperitoneum results from visceral perforation in the great majority of cases (85-95%). It is important to recognize the minority of patients who have non-surgical pneumoperitoneum. The causes of non-surgical pneumoperitoneum include mistaken diagnosis (fat shadow, overdistended hollow viscus), invasive abdominal procedures (surgery, laparoscopy, dialysis, endoscopic gastrostomy), thoracic air leak (mechanical ventilation, COPD, pneumothorax), gynecologic (tubal insufflation, pelvic inflammatory disease), diving decompression and PCI.

Author: Tamara Kindelan


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This page was last modified on 7-Jan-2005.