CASE:
A 55
year old male presented with sudden onset abdominal pain and gaseous distention
since 2 days. On clinical examination, his pulse rate was 76 bpm and blood
pressure was 116/72 mm of Hg. His Hemogram and renal function tests were
normal. X-ray abdomen (Figure A) showed numerous air pockets in the abdomen. CT
scan of the abdomen (Figure B and Figure C) showed shows air-filled cysts within the walls of the small
intestine as a manifestation of a pneumatosis intestinalis (PI).
Discussion :
PI is not in itself a disease, but rather a
clinical sign. In some cases, PI can be primary, whereas in others, it occurs
in life threatening conditions such as bowel ischemia, obstruction etc. Numerous hypotheses have been
proposed to explain the pathogenesis of pneumatosis intestinalis (PI),
including mechanical, bacterial, and biochemical causes. Management
of PI is based upon symptoms once an acute intra-abdominal emergency has been
excluded. For asymptomatic patients, no specific treatment is necessary apart
from treatment of underlying disease, if any present. There are a variety of
treatment options for patients with symptomatic PI, including antibiotics,
special diets, high-flow oxygen therapy, hyperbaric oxygen therapy and surgery.
Reference:
1 Heng Y, Schuffler
MD, Haggitt RC et al. Pneumatosis Intestinalis: a review. Am J Gastroenterol
1995; 90:1747-1758
Wayne E, Ough M, Wu A et al. Management
algorithm for pneumatosis intestinalis and portal venous gas: treatment and
outcome of 88 consecutive cases. J Gastrointest Surg. 2010; 14: 437-448.
Labels: high flow oxygen therapy, hyperbaric oxygen, pathogenesis of pneumatosis intestinalis, pneumatosis, pneumatosis intestinalis
