Pneumatosis cystoides intestinalis and portomesenteric venous gas are uncommon radiological findings, but are found commonly in cases of bowel ischemia, or as a result of various non-ischemic conditions. A 72-year-old man visited an emergency center with altered mental status 2 hours after ingestion of an unknown pesticide. On physical examination, he showed the characteristic hydrocarbon or garlic-like odor, miotic pupils with no response to light, rhinorrhea, shallow respiration, bronchorrhea, and sweating over his face, chest and abdomen. Laboratory results revealed decreased serum cholinesterase, as well as elevated amylase and lipase level. We made the clinical diagnosis of organophosphate poisoning in this patient based on the clinical features, duration of symptoms and signs, and level of serum cholinesterase. Activated charcoal, fluid, and antidotes were administered after gastric lavage. A computerized tomography scan of the abdomen with intravenous contrast showed acute pancreatitis, poor enhancement of the small bowel, pneumatosis cystoides intestinalis, portomesenteric venous gas and ascites. Emergent laparotomy could not be performed because of his poor physical condition and refusal of treatment by his family. The possible mechanisms were believed to be direct intestinal mucosal damage by pancreatic enzymes and secondary mucosal disruption due to bowel ischemia caused by shock and the use of inotropics. Physicians should be warned about the possibility of pneumatosis cystoides intestinalis and portomesenteric venous gas as a complication of pancreatitis following anticholinesterase poisoning.
Abdomen ; Aged ; Amylases ; Antidotes ; Ascites ; Charcoal ; Cholinesterases ; Diagnosis ; Eating ; Emergencies ; Gastric Lavage ; Humans ; Ischemia ; Laparotomy ; Lipase ; Odors ; Organophosphate Poisoning ; Pancreatitis ; Physical Examination ; Pneumatosis Cystoides Intestinalis ; Poisoning* ; Pupil ; Respiration ; Shock ; Sweat ; Sweating ; Thorax ; Treatment Refusal

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.
Anti-Bacterial Agents ; Gastrointestinal Tract ; Humans ; Intestinal Obstruction ; Intestines ; Ischemia ; Oxygen ; Pneumatosis Cystoides Intestinalis ; Prognosis

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition that is characterized by the presence of gas within the bowel wall. We experienced a case of PCI after erlotinib-containing chemotherapy for advanced pancreatic cancer. A 66-year-old woman was admitted to the hospital with intermittent epigastric pain, and she diagnosed with advanced pancreatic cancer accompanied by hepatic metastasis. Combination chemotherapy of gemcitabine and erlotinib was started. PCI occurred about 14 months after start of the chemotherapy but she did not complain of abdominal pain and physical examination showed no evidence of peritoneal irritation sign. Laboratory findings showed no abnormalities. Following conservative treatment for 3 days, no specific symptoms were observed, and abdominal X-ray examination showed reduced abnormal air deposition. Erlotinib-containing chemotherapy was continued and PCI had not recurred.
Abdominal Pain ; Aged ; Drug Therapy* ; Drug Therapy, Combination ; Erlotinib Hydrochloride ; Female ; Humans ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Physical Examination ; Pneumatosis Cystoides Intestinalis*

Pneumatosis cystoides intestinalis (PCI) is a rare disease with intramural gas formation in the gastrointestinal tract. The causes of PCI are various, and are commonly associated with collagen vascular disease. We present a case of a 48-year-old female with dermatomyositis (DM) who also developed PCI. Her risk of PCI may have been increased by multiple factors such as gender, DM itself, and medications including corticosteroids, methotrexate, and azathioprine. While the cause of, and risk factors for PCI in DM patients are not well known on a global scale, outcomes range from benign to life threatening. Therefore, we present a case study and review the literature to identify candidate risk factors for PCI.
Adrenal Cortex Hormones ; Azathioprine ; Collagen ; Dermatomyositis* ; Female ; Gastrointestinal Tract ; Humans ; Methotrexate ; Middle Aged ; Pneumatosis Cystoides Intestinalis* ; Rare Diseases ; Risk Factors ; Vascular Diseases

Portal vein gas and pneumatosis cystoides intestinalis are uncommon conditions and have been associated with poor prognosis. They are most commonly caused by necrotizing enterocolitis but may have other causes, and they can be associated with necrotizing and ischemic colitis, intra-abdominal abscess, small bowel obstruction, diverticulitis, colon cancer, and acute pancreatitis. With the more frequent use of computed tomography (CT) scans, portal vein gas and pneumatosis cystoides intestinalis have been increasingly detected in recent years. Because of its high mortality rate, necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis may be treated with emergent exploratory laparotomy. We report a case of necrotizing enteritis with portal vein gas and pneumatosis cystoides intestinalis in a 47-year-old man treated with intensive medical management and delayed operation due to unstable condition and surgical mortality. He had good clinical results without complications after the delayed operation.
Abdominal Abscess ; Colitis, Ischemic ; Colonic Neoplasms ; Diverticulitis ; Enteritis* ; Enterocolitis, Necrotizing ; Humans ; Laparotomy ; Middle Aged ; Mortality ; Pancreatitis ; Pneumatosis Cystoides Intestinalis* ; Portal Vein* ; Prognosis

Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.
Abdominal Pain ; Gastroenterology ; Humans ; Ileum ; Ischemia ; Laparotomy ; Mesenteric Artery, Superior ; Mesenteric Veins ; Mesentery* ; Middle Aged ; Pneumatosis Cystoides Intestinalis* ; Pneumoperitoneum

Hepatic portal venous gas is a very rare radiologic sign which is characterized by gas accumulation in the portal venous circulation. Pneumatosis intestinalis is also very rare and is characterized by multiple air cysts in the serosal or submucosal layers of the gastrointestinal tract walls. These two findings are caused by various pathological conditions and can develop individually or simultaneously. The latter is clinically more significant because it is frequently related to bowel ischemia or necrosis, and represents a poor prognosis. However, prognosis is more influenced by the severity of underlying disease rather than hepatic portal venous gas or pneumatosis intestinalis itself. If bowel ischemia or necrosis is the primary cause, emergency operation is very important to improve patient's prognosis. Herein, we report a case of necrotizing colitis presenting as hepatic portal venous gas and pneumatosis intestinalis which was successfully managed by early surgery.
Colitis/complications/*diagnosis/surgery ; Humans ; Intestinal Perforation ; Male ; Middle Aged ; Necrosis ; Pneumatosis Cystoides Intestinalis/complications/*diagnosis ; Portal Vein ; Radiography, Abdominal ; Tomography, X-Ray Computed

Pneumatosis cystoides intestinalis (PCI), the presence of air within the bowel wall, could be complicated with connective tissue disease. PCI associated with dermatomyositis has rarely been reported. Here, we report on a case of PCI that occurred in a 60-year-old female patient with dermatomyositis, presenting with epigastric discomfort. PCI with pneumoperitoneum was detected on abdominal computed tomography but improved by conservative management without surgery. Treatment for secondary PCI is associated with underlying disease. Also, identification of serious complication, such as bowel perforation, necrosis, and peritonitis, requiring surgical intervention is important.
Adrenal Cortex Hormones ; Connective Tissue Diseases ; Dermatomyositis* ; Female ; Humans ; Middle Aged ; Necrosis ; Peritonitis ; Pneumatosis Cystoides Intestinalis* ; Pneumoperitoneum

Pneumatosis intestinalis (PI) is a very rare condition that is defined as the presence of gas within the subserosal or submucosal layer of the bowel. PI has been described in association with a variety of conditions including gastrointestinal tract disorders, pulmonary diseases, connective tissue disorders, organ transplantation, leukemia, and various immunodeficiency states. We report a rare case of a 74-year-old woman who complained of dyspnea during the management of acute asthma exacerbation and developed PI; but, it improved without any treatment.
Adrenal Cortex Hormones ; Aged ; Asthma* ; Connective Tissue ; Dyspnea ; Female ; Gastrointestinal Tract ; Humans ; Leukemia ; Lung Diseases ; Organ Transplantation ; Pneumatosis Cystoides Intestinalis ; Pneumoperitoneum* ; Transplants

No abstract available.
Adult ; Colon, Transverse/radiography ; Colonoscopy ; Fibrosis/pathology ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Mucosa/pathology/*surgery ; Male ; Pneumatosis Cystoides Intestinalis/*diagnosis/surgery ; Tomography, X-Ray Computed