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Surgical aspects of pneumatosis cystoides intestinalis: two case reports
Engelbert Schröpfer1, Thomas Meyer
1Department of General, Visceral, Vascular and Transplant-Surgery, Julius-Maximilians-University of Würzburg Würzburg Germany. Schroepfer_e@chirurgie.uni-wuerzburg.de
Insights
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by air-filled cysts in the gastrointestinal tract. Surgical intervention for PCI is recommended only for patients with sepsis, peritonitis, or bowel perforation.
Area of Science:
- Gastroenterology
- Surgical Therapy
- Rare Diseases
Background:
- Pneumatosis cystoides intestinalis (PCI) is a rare condition involving air-filled cysts within the gastrointestinal tract wall.
- PCI is often secondary to an underlying medical condition.
- This study aims to develop a surgical therapy algorithm for PCI.
Observation:
- A 17-year-old girl with Down syndrome and leukemia-related leucopenia presented with septic conditions and PCI.
- A 79-year-old man with urothelial and prostate carcinoma presented with abdominal distension, PCI, and adhesive strangulation.
Findings:
- The pediatric patient underwent exploratory laparotomy and right colon resection due to acute ischemia.
- The adult patient was treated conservatively for PCI after adhesiolysis for intestinal strangulation.
Implications:
- Exploratory laparotomy for PCI should be reserved for patients exhibiting elevated inflammatory markers, sepsis, peritonitis, or bowel perforation.
- Conservative management may be appropriate for select PCI cases without severe complications.
Introduction:
Pneumatosis cystoides intestinalis is a rare disease usually caused by an underlying condition. It is defined as air filled cysts within the wall of the gastrointestinal tract. The purpose of this paper is the development of an algorithm for the surgical therapy of PCI based one two case reports.
Case Presentations:
A 17-year-old girl with Down syndrome and leucopenia due to chemotherapy for acute lymphatic leukemia was admitted with acute septic conditions and PCI. Explorative laparotomy revealed acute ischemia of the right colon and resection of the affected intestine was performed. After a short interval in the intensive care unit the patient was referred to the pediatric department. The second patient, a 79 year old man, with urothelial carcinoma and carcinoma of the prostate presented a distended abdomen. CT-scan revealed PCI and adhesive strangulation of intestines. Therefore only adhesiolysis was performed and PCI was treated conservatively.
Conclusion:
Only patients with increased inflammatory parameters in laboratory findings or signs of sepsis, peritonitis or bowel perforation in combination with PCI should receive an explorative laparotomy.
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