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      Oesophageal pneumatosis in a case of bowel ischaemia

      case-report
      Author(s): , MD 1 , , , MD 2 , , MD 2 , , MD 3
      Publication date (Electronic):
      Journal: BJR Case Reports
      Publisher: The British Institute of Radiology

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          Abstract

          Pneumatosis intestinalis (PI) is a condition in which cystic collections of gas develop within the gastrointestinal wall, forming submucosal or subserosal “bubbles”. The radiologic manifestations are often dramatic and most notably are associated with life-threatening bowel ischaemia. PI may occur as a primary type but is usually secondary in nature, attributable to a wide spectrum of causes (benign and fulminant), ranging from immunosuppression to bowel infarction. Herein, we report a case of massive and extensive PI in a patient with small bowel ischaemia, having both benign and serious clinical origins.

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          Most cited references12

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          The spectrum of pneumatosis intestinalis.

          Shaymaa Abbas, Alan Kelly, D Peter (2002)
          A review of the spectrum of illness associated with pneumatosis intestinalis enables us to identify the probable causes of, the best diagnostic approaches to, and the most appropriate treatments for this condition. A review of all published material in the English language regarding pneumatosis intestinalis was conducted using the PubMed and MEDLINE databases. Any relevant work referenced in those articles and not previously found or published before the limit of the search engine was also retrieved and reviewed. There were no exclusion criteria for published information relevant to the topic. All of the studies cited in the present review make a point that contributes to the portrayal of this condition. In circumstances in which the same point was made in several different studies, not all were cited herein. All published material on pneumatosis intestinalis was considered. Information was extracted for preferentially selected ideas and theories supported in multiple studies. The collected information was organized by theory. Mucosal integrity, intraluminal pressure, bacterial flora, and intraluminal gas all interact in the formation of pneumatosis intestinalis. Radiography and computed tomography are the best diagnostic tests. Nonoperative management should be pursued in most patients, and underlying illnesses should be treated. When acute complications appear, such as perforation, peritonitis, and necrotic bowel, surgery is indicated.
          Article 0 comments Cited 86 times – based on 0 reviews     Review now
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            Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome.

            P Ros, J. Fraser Glickman, H. Ji … (2001)
            The purpose of this study was to analyze the correlation between pneumatosis or portomesenteric venous gas, or both, the severity of mural involvement, and the clinical outcome in patients with small- or large-bowel ischemia. CT scans of 23 consecutive patients presenting with pneumatosis or portomesenteric venous gas caused by bowel ischemia were reviewed. The presence and extent of both CT findings were compared with the clinical outcome in all patients and with the severity and extent of ischemic bowel wall damage as determined by surgery (15 patients), autopsy (three patients), or follow-up (five patients). Seven patients showed isolated pneumatosis, and 16 patients showed portomesenteric venous gas with or without pneumatosis (11 and five patients, respectively). Pneumatosis and portomesenteric venous gas were associated with transmural bowel infarction in 14 (78%) of 18 patients and 13 (81%) of 16 patients, respectively. Nine patients (56%) with portomesenteric venous gas died. Of seven patients with infarction limited to one bowel segment (jejunum, ileum, or colon), only one patient (14%) died, whereas of the 10 patients with infarction of two or three bowel segments, eight patients (80%) died. CT findings of pneumatosis intestinalis and portomesenteric venous gas due to bowel ischemia do not generally allow prediction of transmural bowel infarction, because they may be observed in patients with only partial ischemic bowel wall damage. The clinical outcome of patients with bowel ischemia with these CT findings seems to depend mainly on the severity and extent of their underlying disease.
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              Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features.

              Kyungmouk Steve Lee, Sinchun Hwang, Sandra M Hurtado Rúa … (2013)
              The purpose of this study is to determine the overall proportion of clinically worrisome and benign pneumatosis intestinalis (PI) occurring in patients with cancer and to evaluate associated risk factors and CT features.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Milena Pasquali
                Stefano Leonardo
                Miria Morsiani
                Maurizio Zompatori
                Journal
                Journal ID (nlm-ta): BJR Case Rep
                Journal ID (iso-abbrev): BJR Case Rep
                Journal ID (publisher-id): bjrcr
                Title: BJR Case Reports
                Publisher: The British Institute of Radiology
                ISSN (Electronic): 2055-7159
                Publication date Collection: 2017
                Publication date (Electronic): 29 July 2017
                Volume: 3
                Issue: 4
                Electronic Location Identifier: 20170039
                Affiliations
                [1] 1Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Division of Radiology, S.Orsola-Malpighi Hospital , Bologna, Italy
                [2] 2Department of Radiology, Santa Maria della Scaletta Hospital , Imola, Bologna, Italy
                [3] 3Department of Radiology, Cardiothoracic section, Policlinico Sant Orsola-Malpighi , Bologna, Italy
                Author notes
                Address correspondence to: Milena Pasquali E-mail: milena.pasquali88@ 123456gmail.com
                Article
                Publisher-manuscript ID: bjrcr.20170039
                DOI: 10.1259/bjrcr.20170039
                PMC ID: 6159176
                SO-VID: f0021686-657a-4ce1-9433-23aec20b95ca
                Copyright © © 2017 The Authors. Published by the British Institute of Radiology
                License:

                This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 12 March 2017
                Date revision received : 21 June 2017
                Date accepted : 03 July 2017
                Categories
                Subject: Case Report
                Compound subject: bjrcr, BJR|case reports
                Compound subject: gas-abd, Gastrointestinal and abdominal
                Compound subject: ct, CT

                Data availability:

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