ABSTRACT
ABSTRACT A 69-year-old male patient, smoker, was diagnosed with small cell lung cancer metastatic to lung, liver and central nervous system. He received chemotherapy with carboplatin AUC 5 on day 1 and etoposide 100mg/m2 on days 1, 2 and 3. During the first cycle, the patient presented with febrile neutropenia and abdominal distension. Chest, abdomen and pelvis computed tomography scan was performed and detected gas dissecting the wall of sigmoid colon extending to the mesosigmoid. Patient had no abdominal pain, nausea, vomiting, and on physical examination he had no peritoneal irritation, tachycardia or hemodynamic instability compatible with perforation or acute abdomen. Therefore, the radiological finding was interpreted as pneumatosis intestinalis caused by chemotherapy with etoposide. Pneumatosis resolved after continuous oxygen therapy. The second cycle was administered after a complete resolution of the clinical condition and etoposide dose was reduced by 30%. The patient experienced a remarkable evolution.
RESUMO Paciente do gênero masculino, 69 anos, fumante, diagnosticado com câncer de pulmão de pequenas células, metastático para pulmão, fígado e sistema nervoso central. Foi administrada quimioterapia com carboplatina AUC 5 no dia 1 e etoposídeo 100mg/m2 nos dias 1, 2 e 3. Durante o primeiro ciclo, o paciente apresentou neutropenia febril e distensão abdominal. Tomografias de tórax, abdome e pelve detectaram gás dissecando a parede do cólon sigmoide, com extensão para o mesossigmoide. O paciente não apresentava dor abdominal, náusea, vômito e não tinha sinais de irritação peritoneal, taquicardia ou instabilidade hemodinâmica compatíveis com perfuração ou abdome agudo. O achado radiológico foi interpretado como pneumatose intestinal causada por etoposídeo. A resolução do quadro ocorreu após suplementação de oxigênio. O segundo ciclo foi administrado após resolução completa do quadro, com redução da dose do quimioterápico em 30%. O paciente evoluiu de forma bastante satisfatória.
Subject(s)
Humans , Male , Aged , Pneumatosis Cystoides Intestinalis/chemically induced , Carcinoma, Non-Small-Cell Lung/drug therapy , Etoposide/adverse effects , Lung Neoplasms/drug therapy , Antineoplastic Agents, Phytogenic/adverse effects , Oxygen Inhalation Therapy , Pneumatosis Cystoides Intestinalis/therapy , Carcinoma, Non-Small-Cell Lung/secondary , Etoposide/therapeutic use , Lung Neoplasms/secondary , Antineoplastic Agents, Phytogenic/therapeutic useABSTRACT
Pneumatose cística intestinal é uma doença rara caracterizada pelo acúmulo de gás na parede intestinal estando associada a uma variedade de doenças e procedimentos. Não existe uma história específica, achados de exame físico ou laboratorial que auxiliam no diagnóstico. O tratamento conservador utilizando-se a oxigenioterapia hiperbárica é efetivo, ficando a abordagem cirúrgica indicada quando há complicações.
Pneumatosis cystoides intestinalis is an uncommon disease characterized by an accumulation of gas in the bowel wall, and has been associated with a variety of disorders and procedures. There is no specific history and physical or laboratory findings do not help to diagnose. The treatment conservative with hyperbaric oxygen is effective, and surgery is usually indicated when complications appear.
Subject(s)
Humans , Crohn Disease , Pneumatosis Cystoides Intestinalis , PneumoperitoneumABSTRACT
Pneumatosis cystoides intestinalis (PCI) is a rare condition defined as the presence of multiple gas-filled cysts in the wall of gastrointestinal tract. The etiology and pathogenesis of PCI remain uncertain. It is associated with various medicosurgical conditions, including various pulmonary and gastointestinal diseases, connective tissue diseases and endoscopic procedures. The diagnosis is confirmed by endoscopic puncture and biopsy. PCI in adults, for the most part, show a benign clinical course and better prognosis if the associated disease is well controlled. Infantile PCI is more serious condition and especially associated with necrotizing enteritis. The treatment is usually conservative, However surgical intervention is needed when complications such as intussusception, obstruction, bleeding and perforation develope. We experienced a case of PCI found during the follow-up colonoscopy in a patient taken right hemicolectomy and systemic adjuvant chemotherapy due to colon cancer.