Pneumatosis intestinalis in the adult: benign to life-threatening causes.

OBJECTIVE: The frequency of detection of pneumatosis intestinalis (PI) appears to be increasing. This increase may be the result of increased CT use. New medications and surgical procedures have been reported to be associated with an increase in the incidence of PI. The purpose of this review is to provide an update on the imaging features and clinical conditions associated with PI. CONCLUSION: This article illustrates the imaging findings of PI due to benign and life-threatening causes, with emphasis placed on describing newly associated conditions and also the imaging appearance on CT.

Colonic pseudolipomatosis, microscopically classified into two groups.

BACKGROUND: Colonic pseudolipomatosis is rare and the pathogenesis is controversial. The purpose of the present paper was to clarify endoscopic and histological characteristics of colonic pseudolipomatosis and to discuss the etiology. METHODS: A total of 15 lesions from 14 patients was reviewed. They were able to be histologically classified into two groups on the basis of variety in size of the vacuoles: Group A, the ratio of largest vacuole to smallest vacuole in size is less than three, Group B, the ratio is more than four. RESULTS: Four of 15 lesions were group A, and were endoscopically polypoid or flat lesions covered with normal-looking mucosa. They were microscopically characterized by (i) predominant location in the upper portion of the lamina propria; (ii) no submucosal involvement; (iii) less variation in vacuolar size; and (iv) no association with lymph follicles. The vacuoles of group A contained proteinaceous materials in two of four lesions. Group B (11 lesions) had small elevated mucosa with normal-looking surface or non-elevated reddish mucosa. Microscopically, the lesions were mainly located in the lower portion of the lamina propria, occasionally also in the submucosa, had variable-sized vacuoles, and were related to lymph follicles. CONCLUSION: It is suggested that the vacuoles in group A contain fluid, and may indicate an abnormal stagnation of interstitial fluid. Microscopic appearance of group B is essentially similar to that of pneumatosis coli. It is thought that group B probably results from penetration of gas from the crypts into the mucosa during colonoscopy. It is unclear why group B had a preference for ileocecal valve and an association with lymph follicles.

Neumatosis quística intestinal en síndrome de Crest

Presentamos un caso de neumatosis quística intestinal (NQI) en una paciente de 64 años con diagnóstico de Síndrome de Crest. Esta complicación simulaba un abdomen agudo por perforación de vícera hueca. Las radiografías del abdomen evidenciaron neumoperitoneo y neumatosis quística intestinal. Se le practicó laparotomía y se encontro neumatosis quística intestinal, diagnóstico confirmado con patología.

Pneumatosis intestinalis: a clinical classification.

Review of our experience with pneumatosis intestinalis has allowed identification of three major clinical groups of patients. In each of these groups, the etiology of pneumatosis intestinalis usually can be identified, and it frequently has an ominous prognosis. Treatment should be directed to the underlying condition when possible, and hence must be individualized. Those patients who would be categorized as Group I can simply be kept under observation. Patients in Group II might obtain relief from breathing increased concentrations of oxygen. For patients in Group III vigorous therapeutic measures generally are necessary to ensure survival. The increasing use of mechanically controlled ventilation and positive end-expiratory pressure may be contributing to the incidence of pneumatosis intestinalis. The ileus sometimes observed in these patients may accompany or precede the development of intramural air, a condition identifiable on roentgenographic examination. Awareness of the possible presence of intramural air may help in identifying patients who may not need operation. But even when roentgenographic examination has confirmed the presence of intramural air, abdominal exploration still may be necessary to rule out a diagnosis of perforated viscus. We hope that these concepts and our emphasis upon individualization of treatment may improve the prognosis for patients who have pneumatosis intestinalis.