Cystic intestinal pneumatosis revealed by peritonitis in perforated peptic ulcer: A case report

Authors

  • Dandakoye Soumana Ismael ORCID https://orcid.org/0000-0003-2451-4199
  • Anas Belhaj
  • Moussa Sylla
  • Somuah Tenkorang
  • Mouaqit Ouadii
  • İbn Majdoub Hassani
  • İmane Toughrai
  • Hassan Moulay Farih
  • Khalid Mazaz
  • Ait Taleb Khalid

Keywords:

Cystic intestinal pneumatosis, Cysts, Pneumoperitoneum, Perforated peptic ulcer

Abstract

Cystic intestinal pneumatosis is a rare condition characterized by the presence of cyst-like formations in the walls of the digestive tract. Cystic intestinal pneumatosis can affect any part of the digestive tract. However, the small and large bowels are the most affected. This pathology is more common in men and after the age of 50 years. Cystic pneumatosis of the intestines may be idiopathic or most often secondary to various diseases. The primitive forms preferentially affect the left colon with essentially submucous gaseous cysts, whereas the secondary intestinal cystic pneumatosis tend to affect the small intestines especially in the subserosa. The origin of this pathology is multifactorial but the main cause is not definitively proven. The long list of pathological associations has led to the development of various etiopathogenic theories that are not antinomic since some mechanisms may be associated.

Cystic intestinal pneumatosis is most often asymptomatic and therefore fortuitously discovered. This pathology could have clinical signs like bloody and glairy stools, abdominal pain, and diarrhea. Endoscopic and radiological examinations are easy to diagnose and avoid unnecessary laparotomy explorations in benign pneumoperitoneum. Treatment varies according to its etiology. For primary forms, antibiotic therapy to reduce the hydrogen-producing colonic flora is indicated as first-line treatment. If unsuccessful, oxygen mask or hyperbaric, which will promote the replacement of hydrogen with oxygen, must be attempted. For secondary forms, the treatment is that of the causal affection. In most cases, cystic intestinal pneumatosis is asymptomatic and no treatment is needed. Surgery remains reserved for serious forms of this disease.


Downloads

Download data is not yet available.

References

Boerner RM, Fried DB, Warshauer DM, Isaacs K. Pneumatosis intestinalis. Two case reports and a retrospective review of the literature from 1985 to 1995. Dig Dis Sci. 1996;41:2272-85.

Danse EM, Vanbeers BE, Gilles A, Jacquet I. Sonographic detection of intestinal pneumatosis. Eur J ultrasound 2000;11:201-03.

Rybacj LD, Shopiro RS, Carano K, Halton KP. Massive pneumatosisintestinalis: CT diagnosis. Comput Med Imaging Graph. 1999;23:165-8.

Xavier JL, Boscangi G, Claudel N, et al. La pneumatose kystique intestinale. Ann Radiol. 1991;34:401-6.

Kaassis M, Ben bouali A, Arnaud JP. Pneumatose kystique occlusive du côlon gauche (quelle attitude thérapeutique faut-il adopter?). J Chir. 1995;132:183-5.

Vernoi JG Du. AnatomischeBeobachtung under der Æussen und innern Haut der Gedaermeeingeschlossenen. Luft Phys Med Abhandl Acad Wisseusch Petersb. 1783;2:182.

Jamart J. Pneumatosiscystoides intestinalis-A statistical study of 919 cases. ActaHepatogastroenterol (Stuttg). 1979;26(5):419–22.

Holt S, Stewart IC, Heading RC, Macpherson AI. Resolution of primary pneumatosis coli. J R Coll Surg Edinb. 1978;23(5):297–9.

Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA. Pneumatosis intestinalis: a review. Am J Gastroenterol. 1995;90(10):1747–58.

Grasland A, Pouchot J, Leport J, Barge J, Vinceneux P. Pneumatosiscystoidesintestinalis. Presse Med. 1998;27(35):1804–12.

Guillem P. Radiologic pneumoperitoneum without perforation of a hollow viscus. J Chir (Paris). 2002;139(1):5–15.

Quintart C, Choghari C, Michez D, Lefebvre P, Ramdani B. Pneumatosiscystoides intestinalis - Diagnostic elements and therapeutic approach. Ann Chir. 1997;15(9):1032–5.

Boland C, De Ronde T, Lacrosse M, Trigaux JP, Delaunois L, Melange M. Pneumatosiscystoides intestinalis associated with Steinert disease. Gastroenterol Clin Biol. 1995;19(3):305–8.

Levitt MD, Olsson S. Pneumatosiscystoides intestinalis and high breath H2 excretion: insights into the role of H2 in this condition. Gastroenterology. 1995;108(5):1560–5.

Meikle G. A case of pneumatosis coli: pneumatosiscystoides intestinalis of the sigmoid colon causing intestinal obstruction, stercoral ulcer and perforation. J R Coll Surg Edinb. 1965;11(1):65–7.

Estermann F, Denis B, Gaucher P, Regent D, Sondag D. Pneumatosiscystoides of the colon: knowing how to recognize it -Apropos of 8 cases. Ann Gastroenterol Hepatol (Paris). 1994;30(4):151–5.

Pun YL, Russell DM, Taggart GJ, Barraclough DR. Pneumatosis intestinalis and pneumoperitoneum complicating mixed connective tissue disease. Br J Rheumatol. 1991;30(2):146–9.

Scheidler J, Stabler A, Kleber G, Neidhardt D. Computed tomography in pneumatosis intestinalis: differential diagnosis and therapeutic consequences. Abdom Imaging. 1995;20(6):523–8.

Brientini F, Debilly M, Litzler JF, Raclot G, Le Mouel A. Colonic cystic pneumatosis -A specific x-ray computed tomographic diagnosis: apropos of 2 cases. J Radiol. 1995;76(2-3):135–40.

Kohzaki S, Hayashi K, Fukuda T, Uetani M, Kawano Y, Iriarte WL. Case report: the "aurora sign"--a new sonographic sign of pneumatosiscystoides intestinalis. Br J Radiol. 1994;67(804):1275–7.

Feczko PJ, Mezwa DG, White BD. Clinical significance of pneumatosis of the bowel wall. Radiographics. 1992;12(6):1069–78.

Rogy MA, Mirza DF, Kovats E, Rauhs R. Pneumatosiscystoidesintestinalis (PCI). Int J Colorectal Dis. 1990;5(2):120–4.

Boerner RM, Fried DB, Warshauer DM, Isaacs K. Pneumatosis intestinalis -Two case reports and a retrospective review of the literature from 1985 to 1995. Dig Dis Sci. 1996;41(11):2272–85.

Downloads

Published

2018-09-01

Issue

Section

Case Report

How to Cite

1.
Ismael DS, Belhaj A, Sylla M, Tenkorang S, Ouadii M, Hassani İbn M, Toughrai İmane, Farih HM, Mazaz K, Khalid AT. Cystic intestinal pneumatosis revealed by peritonitis in perforated peptic ulcer: A case report. J Surg Med [Internet]. 2018 Sep. 1 [cited 2022 Aug. 18];2(3):377-9. Available from: https://jsurgmed.com/article/view/426196