Rare Case of Pneumatosis Coli following Mycotic Aneurysm excision

Pneumatosis coli (PC) is a rare radiological phenomenon of the presence of gas in the wall of the large intestine. It carries a large burden of morbidity and mortality. All patients should have their underlying cause of PC investigated and have targeted therapy. In this novel case, a 68-year-old man developed PC following an aorto-bilateral common iliac artery mycotic aneurysm excision. Fortunately, he was asymptomatic and underwent close surveillance of this condition until near resolution. This case highlights the need for correlation of the patient’s symptoms and clinical features with appropriate aetiology and pathogenesis mechanism of the disease to guide management and optimise health outcomes.

Allergic proctocolitis causing hematochezia in preterm twins

Allergic colitis due to cow’s milk or soy protein in commercially prepared infant formula or due to ingestion of breast-milk of mothers who are ingesting cow’s milk is a known cause of colitis occurring in infants. Allergic colitis can occur within days, weeks or months of birth and should be considered as a differential diagnosis in any infant presenting with hematochezia. Typically, there is a significant delay in the onset of milk allergy in premature infants compared to full term infants. We report a case of premature twin neonates who presented with profuse rectal bleeding during second week of life. The infants had been feeding expressed breast milk since birth and the nursing mother had been drinking cow’s milk. The infants had pneumatosis coli suggestive of inflammation of the colon while biochemical and hematological markers of inflammation were normal. Expressed breast milk was re-introduced after eliminating dairy from mother’s diet for 5 days. The infants were fed on mother’s milk and top up of hydrolyzed infant formula as required. Both the twins remained well.

Pneumatosis Coli in a Dog

ABSTRACT The objective of this report is to document a case of pneumatosis coli in an immunosuppressed dog successfully treated with supportive care that included hyperbaric oxygen. A 9 yr old, neutered male Maltese was presented for hematochezia of ∼36 h duration. The dog had a history of immune-mediated thrombocytopenia that was well managed with prednisone and azathioprine. Initial evaluation was unremarkable except for increased rectal temperature and hematochezia on digital rectal examination. Abdominal radiographs revealed diffuse gas within the colonic wall consistent with pneumatosis coli. Scant-free air was also appreciated in the peritoneal and retroperitoneal cavities. The dog was managed for 4 days in hospital with broad spectrum antibiotic, anthelminthic, and gastroprotectant therapy. He received one session of hyperbaric oxygen therapy while in hospital. Repeat abdominal radiographs after 72 hr of medical management showed improvement of the pneumatosis coli. After 4 days of hospitalization, he was discharged with resolution of clinical signs. Pneumatosis coli is rarely diagnosed in dogs but should be considered in cases with clinical signs of colorectal disease.

Pneumatosis Coli Formation via Counterperfusion Supersaturation in a Patient with Severe Diarrhea

We present the case of an elderly male patient with known multiple myeloma who was hospitalized with profuse watery diarrhea and abdominal pain after a course of induction chemotherapy. Intestinal intramural gas was found on imaging and the diagnosis of pneumatosis intestinalis was confirmed by colonoscopy. We propose counterperfusion supersaturation as the etiology for this patient’s pneumatosis coli via disruption of homeostasis between nitrogen and hydrogen normally present in the bowel. His condition was successfully treated with antidiarrheal medications and inhaled oxygen as well as intravenous hydration, and he eventually completed multiple myeloma directed chemotherapy with an excellent response. In this report, we discuss how clinicians can improve management of pneumatosis intestinalis by understanding the proposed pathophysiology.