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International Journal of Surgery Case... Feb 2024Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cyst-like structures in the submucosa and subserosa of the small or...
INTRODUCTION
Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cyst-like structures in the submucosa and subserosa of the small or large intestine and in some cases accompanied by pneumoperitoneum. PCI is commonly considered a benign condition as opposed to pneumatosis intestinalis in life-threatening conditions such as mesenteric ischemia. Only a minority of cases of PCI are assumed to be primary or idiopathic with the majority being caused by a variety of underlying conditions. Symptoms of PCI are non-specific or may be absent altogether. Provided that there is no suspicion of an underlying life-threatening disease, PCI can be treated non-operatively.
CASE PRESENTATION
We present the case of a 71-year-old patient with pneumatosis intestinalis with free intraperitoneal gas known for three years. Due to self-limiting symptoms and lack of evidence of a life-threatening underlying disease, no specific therapy had been carried out so far. No underlying diseases could be found. Because of recurrent worsening abdominal pain and newly diagnosed partial small bowel obstruction with radiological signs of mesenteric torsion, resection of the affected small bowel was successfully performed.
DISCUSSION
Non-surgical management of PCI is possible provided that life-threatening causes of pneumatosis have been ruled out. Bowel obstruction is a rare complication of PCI which requires surgical treatment.
CONCLUSION
Our case report illustrates that symptoms of PCI may worsen over time, and that complications requiring surgical intervention may occur. We recommend regular monitoring of patients who are primarily treated non-operatively.
PubMed: 38194864
DOI: 10.1016/j.ijscr.2024.109220 -
Journal of Surgical Case Reports Nov 2023Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the...
Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. A 35-year-old male patient presented with signs and symptoms of intestinal obstruction. Then the patient was diagnosed with pneumatosis cystoides intestinalis. The patient underwent surgery, and antibiotic treatment, and was discharged improved with no incident. Pneumatosis cystoides intestinalis is a surgical condition that resembles other life-threatening top surgical emergencies and affects clinicians' decisions on diagnosis and treatment plans substantially, mainly in low-income countries. So, surgeons have to consider such kind of conditions and avoid the costs and morbidities associated with unnecessary bowel resection or surgery.
PubMed: 38026738
DOI: 10.1093/jscr/rjad612 -
Journal of Medical Case Reports Oct 2023Behçet's disease (BD) is a chronic systemic disease characterized by vasculitis as the basic pathological change. BD is rare, and gastrointestinal involvement occurs in... (Review)
Review
BACKGROUND
Behçet's disease (BD) is a chronic systemic disease characterized by vasculitis as the basic pathological change. BD is rare, and gastrointestinal involvement occurs in 3% to 25% of affected patients. This article describes a rare case of intestinal BD along with a literature review of intestinal involvement in BD.
CASE PRESENTATION
A 50-year-old Han woman from China presented with a > 6-month history of distending pain in the right upper abdomen. Because of mechanical obstruction secondary to stricture formation from an ileocecal ulcer, she underwent radical right colon resection, and postoperative pathologic examination indicated an ileocecal ulcer. The patient was readmitted to the hospital 6 months postoperatively for recurrence of the same symptoms. Colonoscopy indicated obvious narrowing of the anastomosis with an oval-shaped deep ulcer that could not be passed by the endoscope. Pathologic examination showed acute and chronic inflammation of the anastomotic mucosa and granulation tissue. In addition, gastroscopy showed a 3.0- × 4.0-cm giant ulcer at the junction of the descending bulb along with a sinus tract. Moreover, total gastrointestinal computed tomography angiography showed significant thickening of the intestinal wall near the transverse colon, forming a sinus tract at the junction of the antrum and duodenum with a length of about 1.3 cm and width of about 0.2 cm. Further inquiry regarding the patient's medical history revealed that she had developed repeated oral ulcers 3 years previously and repeated eye inflammation 5 years previously. Specimens of the right half of the colon removed 6 months previously were sent to Run Run Shaw Hospital Affiliated to Zhejiang University for consultation. The pathologic examination revealed vasculitis in the submucosa and subserosa, and the patient was finally diagnosed with BD. She began treatment with adalimumab, and repeat gastroenteroscopy revealed that the intestinal ulcer had significantly improved.
CONCLUSIONS
An oval-shaped deep intestinal ulcer is a characteristic lesion in patients with BD and may involve the intestinal muscle layer. This case emphasizes that BD is a vasculitis affecting multiple organs and can present with a single, deep, clean-edged intestinal ulcer that penetrates the bowel wall to form a sinus tract. Therefore, careful examination and differential diagnosis should be carried out to prevent a poor prognosis. Adalimumab is effective for patients with intestinal BD.
Topics: Female; Humans; Middle Aged; Behcet Syndrome; Ulcer; Adalimumab; Intestinal Diseases; Inflammation; Vasculitis
PubMed: 37798676
DOI: 10.1186/s13256-023-04148-w -
GE Portuguese Journal of... Nov 2023Eosinophilic gastroenteritis (EoG) is a rare condition with a yet poorly understood pathophysiology.
INTRODUCTION
Eosinophilic gastroenteritis (EoG) is a rare condition with a yet poorly understood pathophysiology.
CASE PRESENTATION
We report on a case of a 36-year-old woman with a history of atopy presenting with nausea, abdominal discomfort, weight loss, and ascites. Laboratorial analysis revealed peripheral eosinophilia and a slight elevation of inflammatory markers. The patient pursued medical assistance several times with a delay in the diagnosis. The pathway to the diagnosis of EoG with serosal infiltration and further management is presented.
DISCUSSION
Despite being diagnosed by exclusion, it is important to suspect EoG with subserosa involvement in patients presenting with the uncommon association of peripheral eosinophilia and ascites, particularly if there is a history of atopy.
PubMed: 38020819
DOI: 10.1159/000525809