Pneumatosis Intestinalis

Pneumatosis intestinalis is an uncommon condition in which gas is found in a linear or cystic form in the submucosa or subserosa of the bowel wall (8). This paper will look at the epidemiology, clinical manifestations, pathological findings, pathogenesis, clinical course and management of pneumatosis intestinalis.

Pneumatosis intestinalis is not a disease per se, but a sign, and therefore its relevance should be interpreted within the whole clinical context within which it occurs (8). It has been found in several distinctive clinical settings: in premature infants with necrotizing enterocolitis; in adults with obstructive pulmonary disease; in adults and children with a wide variety of associated conditions, including pyloric stenosis, jejunoileal bypass, progressive ischemic sclerosis, transplantation, ischemic bowel, and drug therapy, particularly steroids, chemotherapy and immunosuppression; in adults as a primary benign problem; and as an incidental finding in endoscopic mucosal biopsies.

Galadiuk and Fazio present five principle causes of pneumatosis Intestinalis which are often interrelated: mechanical, bacterial, chemical, dietary, and neoplastic (5). The mechanical causes either results from intestinal gas entering the bowel wall through a break in the bowel mucosa and being carried along by peristalsis, or from pulmonary air being forced into the submucosal or subserosal layers of the bowel from broken alveoli, with dissection into the mediastinum and subse

racteristics of the mesothelium, but not the capillary endothelia. Contrary to previous assumptions, these researchers believe that pneumatosis intestinalis apparently does not develop from cystic dilatation of gas-filled lymph vessels that shrink and disappear in the process of an inflammatory foreign-body reaction. Instead, the disease seems to manifest itself through gas-filled pseudocysts partially bordered by histiocytes and foreign-body giant cells, which become secondarily mesothelialized in the subserosa. Lymph vessels would thus not have significance for the morphogenesis of the disease. Intestinal pneumatosis, being an infrequently seen disease, is difficult to diagnosis clinically and radiologically (1). It may be accompanied by pneumoperitoneum in up to 10 percent of cases, leading to differential diagnosis with pictures of visceral perforation. Diagnosis may occur intraoperatively in patients admitted for emergency surgery because of an associated acute gastrointestinal event, such as intestinal volvulus or acute cholecystitis. Other cases can be diagnosed by computerized tomography or colonoscopy. Pneumatosis cystoides intestinal is a benign air-filled cystic formation lying in submucosal or subserosal dig

Category: Medical - P