Gastritis enfisematosa como causa infrecuente de abdomen agudo / Emphysematous gastritis as an infrequent cause of acute abdominal pain

La gastritis enfisematosa (GE) es una entidad poco frecuente, descripta por primera vez por Fraenkel en 1889. Se caracteriza por la invasión de la pared gástrica por gérmenes productores de gas, y se asocia a una alta morbimortalidad. Se describen en la bibliografía diferentes factores de riesgo que favorecerían su desarrollo, entre ellos ingesta de cáusticos, diabetes, abuso de alcohol, isquemia gástrica y cirugía de estómago. El cuadro clínico se caracteriza por dolor abdominal agudo y progresivo asociado a repercusión sistémica, sepsis severa, shock séptico, disfunción orgánica múltiple y muerte. Los métodos de diagnóstico por imágenes cumplen un rol fundamental en su abordaje, siendo la tomografía computada multidetector (TCMD) el método de elección, ya que cuenta con la capacidad de mostrar la presencia de gas en el interior de la pared gástrica (neumatosis gástrica) en asociación con el aumento de su espesor, siendo estos dos hallazgos la clave en el diagnóstico. También se encuentra presente un aumento de la densidad del tejido perigástrico compatible con cambios de tipo inflamatorio o infeccioso, y en algunas ocasiones se asocia a neumatosis portal. Se realiza una actualización del tema enfatizando el rol de la TCMD para su diagnóstico.

Emphysematous gastritis (EG) is a rare entity first described in 1889. It is characterized by the invasion of the gastric wall by gas-producing bacteria, and is associated with high morbidity and mortality. The clinical picture is characterized by acute abdominal pain associated with progressive systemic repercussions, severe sepsis, septic shock, multiple organ dysfunction, and death. Imaging methods play a fundamental role in the diagnosis. Multidetector Computed Tomography (MDCT) is the method of choice, since it has the ability to show the presence of gas within the gastric wall (gastric pneumatosis) in association with increased wall thickness. These two features are key findings for diagnosis. Increased density of perigastric tissue is frequently present, due to infectious or inflammatory changes; sometimes portal pneumatosis is present as well. An update on EG is presented, emphasizing the role of MDCT in diagnosis.

Pneumatosis cystoides intestinal is: a case report

This study presents a case of pneumatosis cystoides intestinalis affecting the terminal ileum in a 25-year old male patient, discovered accidentally during laparotomy for acute abdomen which was proved to be due to perforated duodenal ulcer, Pneumatosis cystoides intestinalis is characterized by the presence of subserosal or submucosal gas filled cysts in the wall of gastrointestinal tract, this condition is rarely seen in the surgical practice

Neumatosis intestinal: caso clínico-radiológico / Pneumatosis intestinalis: a case report

The case of a women 89 year old with an apparent partial intestinal obstruction is presented. The CT scan of abdomen and pelvis shows evident pneumatosis intestinalis (PI) within gas in the portal system. Expectant medical treatment was performed. Eight days later, a second CT scan showed almost complete remission of pneumatosis and gas in the portal system. The presence of gas in the bowel wall is a sign that can be find in benign to life threatening conditions. A review of the pathogenesis, radiological presentation and the different causes of PI are presented, based in the case report.

Presentamos el caso de una mujer de 89 años que ingresa por un probable cuadro de suboclusión intestinal. El estudio con TAC de abdomen y pelvis revela extensa neumatosis intestinal (NI) asociada a la presencia de gas en el sistema porta. Se realiza manejo médico de la paciente. Al octavo día se hace un control tomográfico, observándose regresión casi completa de la NI y del gas en sistema porta. La presencia de gas en la pared intestinal es un hallazgo que puede tener múltiples significados, desde lo más benigno hasta situaciones que ponen en riesgo la vida. A continuación revisamos las diferentes causas y teorías que explican la NI, su presentación radiológica e interpretación clínica, en base al presente caso clínico.

Pneumatosis intestinalis of small bowel in an adult: a case report

Pneumatosis Intestinalis [PI] is rare in adults although it can be seen in the pediatric population as a complication of necrotizing enterocolitis. We report a case of PI affecting the small bowel in a 27-year-old patient who presented with signs and symptoms of acute abdomen due to perforated duodenal ulcer. Histopathologic findings are demonstrated and the pathogenesis is discussed with the objective of highlighting that PI is not a diagnosis but a finding which needs further evaluation and management in view of the underlying etiology

Neumatosis intestinal y alergia a la proteina de la leche de la vaca / Pneumatosis intestinalis and cow's milk proteine allergy

Pneumatosis intestinalis in newly born infants constitutes a clinical manifestation greatly associated with the presence of necrotizing enterocolitis, a highly severe medical condition. This study provides a clinical case series presenting with bloody stools and benign pneumatosis intestinalis. A short colonoscopy proven diagnosis of allergic colitis was made, which was confirmed in the 87,5 percent (7/8) of the cases, while a number of biopsies showed eosinophiles exceeding the normal ranges. Diagnosis in 12,5 percent of patients (1/8) was based on clinical records, lab-tests, imaging and treatment responses. The suppression of cow's milk protein in the maternal diet or the replacement of human milk by a substitute free from that protein led to a rapid regression of symptomatology.

La neumatosis intestinal en el recién nacido es un signo que se asocia mayoritariamente a la presencia de enterocolitis necrotizante, una condición grave. Se presenta una serie de casos clínicos que debutaron con sangre en la deposición y neumatosis intestinal de curso benigno, diagnosticándose una colitis alérgica, que fue demostrada en el 87,5 por ciento (7/8) de los casos mediante colonoscopía corta y biopsias que demostraron un número de eosinófilos mayor que lo normal; en el 12,5 por ciento (1/8) el diagnóstico se basó en clínica, laboratorio, imágenes y respuesta a tratamiento. La supresión de la proteína de la leche de vaca en la dieta de la madre o el reemplazo de la leche materna por un sustituto libre de esta proteína, llevó a una rápida regresión de la sintomatología.

A Case of Pneumatosis Cystoides Intestinalis: Diagnosed by CT Colonoscopy / 대한소화기학회지

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas filled cysts in the intestinal wall. The diagnosis of PCI is usually made by colonoscopy, histology, or radiologic findings. We report a case of PCI in a 35-year-old man. The patient initially complained of watery diarrhea and abdominal bloating for 2 weeks. Simple abdominal X-ray demonstrated numerous, small, round, air densities on the right upper abdomen along the ascending and proximal transverse colon. Colonoscopy revealed numerous, 5-20 mm sized, sessile polypoid, balloon-like distended, protruding subepithelial masses covered with normal colonic mucosa from cecum to proximal transverse colon. We performed a CT colonoscopy and confirmed PCI with multiple air-filled cystic masses along the colonic wall from cecum to proximal transverse colon. The patient was treated with antibiotics and oxygen inhalation for 2 weeks. Follow-up CT colonoscopy revealed marked regression in the number and size of the air-filled cystic masses. Herein, we report the first case of the PCI in Korea diagnosed by CT colonoscopy. Follow-up evaluation with CT colonoscopy was performed after the treatment of the PCI. CT colonoscopy is a useful non-invasive diagnostic tool for the diagnosis of pneumatosis cystoides intestinalis.

Observación de un caso de neumatosis quística de intestino delgado / Report of a case of cystic pneumatosis of the small intestine

Se presenta un caso de neumatosis quística de intestino delgado, resecado en el curso de una laparotomía por ulcus péptico perforado. Se analiza la morfología de esta lesión desde el punto de vista anatomopatológico, confirmándose nuevamente la secuencia lesional descrita previamente por nosotros en una observación con la misma topografía en el año 1986. Se discute el tratamiento realizado y se enfatiza la abstención quirúrgica en los casos no complicados y el correcto tratamiento de la condición patológica que parece generar la producción de estas lesiones. Se recalca la regresión espontánea de este fenómeno mencionado en la literatura; en reoperaciones y autopsias y también al parecer en el caso que analizamos. Con esta comunicación deseamos agregar un nuevo caso a la casuística nacional de esta rara patología

Gas Cysts of the 3ejunum. [Pneumatosis cystoides intestinalis]: report of a case

Gas cysts of the gwstro-intestinal tract although commonly found in animals yet the condition is rare in man. The cysts vary in size from a millimetre to several centimetres. The cysts are grouped in clusters and in most cases they are subserous, but occasionally they arise in the submucous layer of the intestine. In over 50% .of cases there is a peptic ulcer with some degree of obstruction. The case reported was discovered in a patient with chronic pyloric obstruction and, the ileum was the only area affected. The various theories of these cyst formation are mentioned and m man the mechanical theory fits more soundly together with the deficiency theory. A case of gas cysts of the jejunum and associated with pyloric obstruction was found accidentally during laparatomy. The various theories regarding the formation of these cysts are mentioned together with the pathological picture are discussed. The rationale of treatment is to leave these cysts alone unless they are the cause of intestinal obstruction