Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas-filled cysts in the intestinal wall. Although rare, it may also involve other regions, such as the mesentery. PCI is classified as primary or secondary and is associated with multiple predisposing factors. It may be associated with either a benign condition or a potentially fatal condition, such as mesenteric ischemia. The objective of this study was to review the medical literature on the rare benign presentations of PCI, excluding cases associated with intestinal ischemia.Methods: We conducted a systematic literature review according to the PRISMA statement. We searched PubMed and LILACS databases for articles published between January 2015 and December 2020 using the following Medical Subject Headings: "pneumatosis cystoides intestinalis" and "pneumoperitoneum," "pneumatosis intestinalis," and "pneumoperitoneum" or "mesenteric pneumatosis."Results: We included 51 articles comprising 58 patients with PCI and pneumoperitoneum. Most patients were men, and mean patient age was 64.9 years. We identified an idiopathic etiology in 29.31% of cases, and the most common predisposing factor was immune dysfunction (29.31%). A total of 24.13% of patients were asymptomatic. The most commons symptoms were abdominal pain (43.10%), nausea and vomiting (41.37%), and abdominal distention (37.93%). Diagnostic surgery was conducted in 26 patients (44.82%). Only 1 patient underwent surgical treatment.Conclusions: PCI is a clinical condition that may have a benign etiology and not require surgery. Treatment of the benign etiology is conservative. Thus, life-threatening conditions should be excluded in all cases.

Severe cholestatic syndrome secondary to Graves' disease

This paper reports a case of severe cholestasis as an atypical manifestation of Graves' disease. It discusses the pathophysiology, the diagnosis and the investigation of this complication of hyperthyroidism as well as the impact of this finding on the therapeutic options for managing the disease. (AU)

Cistoadenoma mucinoso de apêndice / Mucinous cystadenoma of the appendix

O presente trabalho relata o caso de paciente do sexo feminino que foi encaminhada ao médico cirurgião por apresentar dor na fossa ilíaca direita e alterações em exames radiológicos na topografia do apêndice cecal. Ela foi examinada no consultório e prontamente encaminhada para internação no Hospital Miguel Piltcher, na cidade de Pelotas-RS, onde submeteu-se apendicectomia.

This paper reports the case of a female patient who was referred to a surgeon for presenting pain in the right iliac fossa and changes in radiological studies on the topography of the cecal appendix. She was examined in the office and promptly sent to Hospital Miguel Piltcher in the city of Pelotas, RS, where she was subjected to appendectomy.