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  • • Gas filled cysts in the wall of the intestine and mesentery

    • May be primary and idiopathic; an incidental finding; or secondary to chronic obstructive pulmonary disease, infectious gastroenteritis, or connective tissue disorders

    • Fulminant pneumatosis is associated with bacterial infection and necrosis of the bowel wall.

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Epidemiology

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  • • Characterized by gas-filled cysts in the wall of the gut and mesentery

    • 15% of cases are primary and idiopathic

    • Secondary pneumatosis comprises 85% of cases; cysts may be located anywhere in the GI tract

    • Conditions that underlie secondary pneumatosis intestinalis include:

    • -Inflammatory bowel disease

      -Infectious gastroenteritis

      -Corticosteroid therapy

      -Connective tissue disorders

      -Intestinal obstruction

      -Diverticulitis

      -Chronic obstructive pulmonary disease

      -Acute leukemia

      -Lymphoma

      -AIDS

      -Organ transplantation

    • Fulminant pneumatosis is associated with acute bacterial infection and necrosis of the bowel wall, usually associated with intestinal infarction; pneumoperitoneum is sometimes present

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Symptoms and Signs

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  • • Abdominal discomfort

    • Diarrhea

    • Passing of excessive amounts of gas

    • Abdominal distention

    • Abdominal tenderness

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Laboratory Findings

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  • • Nonspecific in most cases

    • When associated with intestinal necrosis:

    • -Leukocytosis

      -Metabolic acidosis

      -Increased serum lactate

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Imaging Findings

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  • Abdominal x-rays and CT scan: Linear gas deposits in the intestinal wall; if perforation is present, free air may be visualized

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  • • Pneumatosis intestinalis may be an incidental finding (primary and most cases of secondary pneumatosis) or indicative of bowel wall necrosis with gas produced by invading bacteria

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Rule Out

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  • • Intestinal ischemia

    • Strangulation obstruction

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  • • Abdominal x-ray or CT scan

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When to Admit

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  • • Suspected intestinal necrosis

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  • • Primary and secondary pneumatosis: No specific treatment; oxygen administration may lead to resolution

    • Fulminant pneumatosis: Bowel resection

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Surgery

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Indications

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  • • Intestinal necrosis

    • Intestinal ischemia

    • Strangulation obstruction

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Contraindications

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  • • Idiopathic pneumatosis

    • Secondary pneumatosis associated with systemic disease without bowel necrosis

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Medications

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  • • Oxygen administration

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Complications

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  • • Perforation if associated with necrosis

    • Sepsis

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Prognosis

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  • Primary and secondary: Excellent

    Fulminant: High mortality related to intestinal necrosis

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References

Deniz K et al: Intestinal involvement in Wegener’s granulomatosis. J Gastrointestin Liver Dis 2007;16:329.  [PubMed: 17925931]
Ebert EC: Gastric and enteric involvement in progressive systemic sclerosis. J Clin Gastroenterol 2008;42:5.  [PubMed: 18097282]

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