Pneumatosis cystoides intestinalis: an experience with hyperbaric oxygen treatment

Gut wall gas cysts are uncommon and are an occasional cause of abdominal symptoms. Their aetiology is uncertain and both bacterial infection and chronic airways disease are popularly held theories. At Prince Henry Hospital (PHH) between 1980 and 1986, 8 patients with pneumatosis cystoides intestinalis (PCI) underwent 11 courses of hyperbaric oxygen treatment (HBO). This is the largest reported series of HBO treatment of PCI. In April 1990 attempts were made to recall all patients to assess cyst and symptom status. Two had died from unrelated causes; the other six were reviewed--of these, one declined further endoscopy and the other five consented. The 11 courses of treatment all resulted in pronounced symptomatic responses. This was followed by 7 early symptomatic recurrences and 4 long-term cures. These four remain asymptomatic and cyst-free at a minimum of 4 years to a maximum of 9 years follow-up. Of these 4 cures, cyst resolution was documented immediately post-HBO treatment in two and not assessed in two. In the 7 recurrences, failure of cyst resolution was documented immediately post-HBO treatment in six and not assessed in one. Three patients had chronic airways disease, and two of these have complete resolution of PCI. It is concluded that HBO treatment is effective for PCI provided it is continued until cyst resolution has occurred and not just until symptomatic improvement. These observations suggest that PCI is curable and argues against the pulmonary theory of aetiology.