Pneumatosis Cystoides Intestinalis

Abstract

Pneumatosis cystoides intestinalis is characterized by multiple gas cysts in the wall of the gastrointestinal tract. Primary pneumatosis intestinalis is extremely rare. In the more frequent secondary forms small intestine and the right side of the colon are mainly affected, and the underlying pathology can be gastrointestinal, pulmonary or immunological. The cysts are thin walled and break easily. Spontaneous rupture gives rise to pneumoperitoneum. Symptoms are nonspecific, and in pneumatosis associated with other disorders, the symptoms may be those of the associated disease. Complications associated with pneumatosis cystoides intestinalis occur in approximately 3% of cases and include volvulus, intestinal obstruction, hemorrhage, and perforation. Pneumoperitoneum occurs in these patients, usually in association with small bowel rather than large bowel pneumatosis. Pneumatosis cystoides intestinalis represents one of the few cases of sterile pneumoperitoneum and should be considered in the patient with free abdominal air but no evidence of peritonitis. The diagnosis is usually made radiographically by plain abdominal or barium studies. Computed tomography can be used to confirm the diagnosis. Visualization of intestinal cysts has also been described by ultrasound. Most published cases of pneumatosis cystoides intestinalis with radiological finding of pneumoperitoneum have been treated conservatively and should have not been considered as a reason for surgery. Surgical intervention is indicated only in acute complications, such as perforation, peritonitis, bowel necrosis, or tension pneumoperitoneum. Several reports have indicated the advantages of hyperbaric oxygen therapy in the management of pneumatosis cystoides intestinalis. It is stressed that hyperbaric oxygen treatment is effective provided it is continued until cyst resolution has occurred and not just until symptomatic improvement. Disadvantages of normobaric oxygen treatment are that excessive amounts of 100% oxygen are required to be inhaled for prolonged periods and this may produce pulmonary oxygen toxicity