scholarly journals Intramural Gas: Would it be Life-threatening?

2020 ◽  
pp. 63
Author(s):  
Azna Aishath Ali ◽  
Syamim Johan ◽  
Firdaus Hayati ◽  
Chiak Yot Ng
Keyword(s):  
Bowel Wall ◽  
Neoadjuvant Treatment ◽  
Gas Bubbles ◽  
Pneumatosis Intestinalis ◽  
Hepatic Flexure ◽  
Life Threatening ◽  
Rectal Mass ◽  
Localized Disease ◽  
Cect Scan ◽  
Intramural Gas

The CECT scan of the abdomen at axial and coronal views show gas bubbles tracking along the inner wall of the ascending colon and hepatic flexure, which is separated from the intraluminal gas within the bowel. These intramural gas bubbles appear to be outlining the bowel wall circumferentially. The bowel wall appears to be thickened however the inner mucosa is not enhanced. There are no ascites in the images provided. The colon of the hepatic flexure and transverse colon appears dilated. No significant atherosclerotic plaque in the visualised arteries. Based on the clinical presentations and CECT features in Figure 1 and Figure 2, the best diagnosis for him is benign pneumatosis intestinalis (PI) secondary to obstructed low rectal cancer. He was subjected for a trephine transverse colostomy to relieve the obstruction with simultaneous transanal rectal mass biopsy. Once the histology is available, he subsequently will be referred for concurrent chemo-radiotherapy as neoadjuvant treatment and later for a low anterior resection, provided that it is a localized disease.

scholarly journals Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

2018 ◽  
Vol 64 (6) ◽  
pp. 543-548 ◽  
Author(s):  
Sujin Ko ◽  
Seong Sook Hong ◽  
Jiyoung Hwang ◽  
Hyun-joo Kim ◽  
Yun-Woo Chang ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Statistical Significance ◽  
Pneumatosis Intestinalis ◽  
Bowel Distension ◽  
Wall Defect ◽  
Ct Findings ◽  
Free Air ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Ct Features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

scholarly journals Benign pneumatosis intestinalis: a cause of massive pneumoperitoneum in the adult

CJEM ◽  
2003 ◽  
Vol 5 (06) ◽  
pp. 416-420 ◽  
Author(s):  
David M. Liu ◽  
William C. Torreggiani ◽  
Kevin Rowan ◽  
Savvas Nicolaou
Keyword(s):  
Bowel Wall ◽  
Surgical Intervention ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Benign Condition ◽  
Distinguishing Features

ABSTRACT Pneumatosis intestinalis (gas in the bowel wall) is often a benign condition, but it may mimic bowel ischemia or infarction and lead to unnecessary surgical intervention, especially when associated with pneumoperitoneum. We present a case of benign pneumatosis intestinalis with massive pneumoperitoneum and discuss various distinguishing features that may aid in its diagnosis.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

scholarly journals Is the Histopathological Subtype Important for Tumor Response to Irradiation in non-metastatic Esophageal Cancers

2020 ◽  
Vol 71 (6) ◽  
pp. 205-211
Author(s):  
Xenia Elena Bacinschi ◽  
Rodica Maricela Anghel ◽  
Monica Irina Stanuica ◽  
Inga Safta ◽  
Alina Paunescu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Survival Data ◽  
Median Overall Survival ◽  
Neoadjuvant Treatment ◽  
Relapse Free Survival ◽  
Middle Income ◽  
Free Survival ◽  
Middle Income Countries ◽  
Localized Disease ◽  
Histopathological Subtype

Esophageal cancer is still a health problem in middle income countries. The up-front treatment in localized disease is crucial for a better survival. Data from literature are in favor of a better response to radiotherapy of squamous histology. We have run a retrospective study to compare the response of histological subtypes of esophageal cancer to radiotherapy according to irradiation. Of 44 cases (53.7%) of squamous cell localized esophageal carcinoma and 38 (46.3%) of adenocarcinoma, the response after radiotherapy containing multimodal neoadjuvant treatment was 29.5% (13pts) versus 39.5% (15pts) (p=0.475). No correlation was found between histology and tumor shrinkage. Survival was found similar between the two subgroups. Indeed, median relapse free survival was 11 months for both groups with 95% CI [8.86-13.13] or 95% CI [4.526-17.47], log rank 0.394 and median overall survival was 12 months, 95% CI [9.44-14.55] in squamous versus 15 months, 95% [8.30-21.69] in adenocarcinoma cases, log rank 0.195. In univariate regression, the median relapse free survival was significantly associated with irradiation dose and the concomitance of chemotherapy to radiotherapy, while in multivariate analysis only the last variable remained significant: HR 0.425, 95% CI [0.225-0.806], p=0.009. Our analysis showed a tendency to a better response in adenocarcinoma esophageal cancer after multimodal radiotherapy containing treatment.

Pneumatosis intestinalis: benign or life‐threatening?

2019 ◽  
Vol 90 (9) ◽  
pp. 1790-1792
Author(s):  
Chi Lap Nicholas Tsang ◽  
Christopher Seng Hong Lim ◽  
Michelle Zhiyun Chen ◽  
Yeng Kwang Tay ◽  
Kim‐Chi Phan‐Thien
Keyword(s):  
Pneumatosis Intestinalis ◽  
Life Threatening

scholarly journals Antineutrophil Cytoplasmic Antibody–associated Glomerulonephritis Complicated by Pneumatosis Intestinalis

2015 ◽  
Vol 8 ◽  
pp. CCRep.S26155 ◽  
Author(s):  
Saki Nakagawa ◽  
Tetsu Akimoto ◽  
Shin-ichi Takeda ◽  
Mari Okada ◽  
Atsushi Miki ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Bowel Wall ◽  
Pneumatosis Intestinalis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Current Case ◽  
Anca Associated Vasculitis ◽  
Characteristic Imaging

Pneumatosis intestinalis is a characteristic imaging phenomenon indicating the presence of gas in the bowel wall. The link between pneumatosis intestinalis and various kinds of autoimmune diseases has been reported anecdotally, while information regarding the cases with antineutrophil cytoplasmic antibodies (ANCA)–associated vasculitis complicated by concurrent pneumatosis intestinalis is lacking. In this report, we describe our serendipitous experience with one such case of pneumatosis intestinalis in a patient with ANCA-associated glomerulonephritis. We also discuss several therapeutic concerns that arose in the current case, which had an impact on the pathogenesis of the disease.

scholarly journals Pneumatosis Cystoides Intestinalis after Cetuximab Chemotherapy for Squamous Cell Carcinoma of Parotid Gland

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Christos Petrides ◽  
Neofytou Kyriakos ◽  
Ioannou Andreas ◽  
Parpounas Konstantinos ◽  
Georgiou Chrysanthos ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Bowel Wall ◽  
Gastrointestinal Disease ◽  
Radiographic Finding ◽  
Pneumatosis Intestinalis ◽  
Ct Scans ◽  
Abdominal Radiographs ◽  
Cetuximab Therapy

Pneumatosis intestinalis, defined as gas in the bowel wall, is often first identified on abdominal radiographs or computed tomography (CT) scans. It is a radiographic finding and not a diagnosis, as the etiology varies from benign conditions to fulminant gastrointestinal disease. We report here a case of pneumatosis intestinalis associated with cetuximab therapy for squamous cell carcinoma of head and neck. The patient underwent laparotomy based on the CT scan and the result was pneumatosis intestinalis without any signs of necrotizing enterocolitis.

scholarly journals A rare case scenario: spontaneous diaphragmatic rupture during labor

2021 ◽  
Vol 8 (7) ◽  
pp. 2241
Author(s):  
Shambhu Nath Agrawal ◽  
Amit Verma ◽  
Sunil Kedia ◽  
Amol Padegaonkar ◽  
Hari Shankar Mahobia
Keyword(s):  
Surgical Intervention ◽  
Hepatic Flexure ◽  
Diaphragmatic Rupture ◽  
Prior History ◽  
Case Scenario ◽  
Term Delivery ◽  
Life Threatening ◽  
History Of ◽  
Full Term Delivery ◽  
Complications And Mortality

Diaphragmatic rupture during labor is not a very common presentation and usually occurs in patients with prior history of traumatic chest or abdominal injury or any congenital abnormality. We presented a case of a 29 year old woman who presented with sudden breathing difficulty two days after a full-term delivery by caesarean section. e-FAST scan suggested the presence of a massive pleural effusion over right side. CT scan of chest revealed large rent in right diaphragm with superior migration of liver and hepatic flexure. Patient was taken for emergent surgical intervention, inter coastal drainage (ICD) tube was placed and surgical repair was performed, patient was further treated in critical care unit, the patient recovered well and was discharged. Though diaphragmatic hernia rupture during labor are not reported often it is life threatening complication that requires immediate surgical intervention to prevent major complications and mortality.

scholarly journals Pneumatosis intestinalis an increasingly common radiological finding, benign or life-threatening? A case series

2015 ◽  
Vol 2015 (feb18 1) ◽  
pp. bcr2014207234-bcr2014207234 ◽  
Author(s):  
H. A. Blair ◽  
R. Baker ◽  
R. Albazaz
Keyword(s):  
Radiological Finding ◽  
Case Series ◽  
Pneumatosis Intestinalis ◽  
Life Threatening

scholarly journals Pneumatosis intestinalis: cost paid for rheumatoid arthritis treatment

2019 ◽  
Vol 12 (7) ◽  
pp. e229329 ◽  
Author(s):  
Pratyusha Tirumanisetty ◽  
Jose William Sotelo ◽  
Michael Disalle ◽  
Meenal Sharma
Keyword(s):  
Rheumatoid Arthritis ◽  
Bowel Wall ◽  
Loop Ileostomy ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Right Hemicolectomy ◽  
Necrotic Bowel ◽  
History Of ◽  
High Index Of Suspicion

A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.

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