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Pneumatosis Coli Formation via Counterperfusion Supersaturation in a Patient with Severe Diarrhea

Eric Vecchio1, Sehrish Jamot1, Jason Ferreira1

  • 1Rhode Island Hospital and Brown University, USA.

Case Reports in Gastrointestinal Medicine
|August 30, 2018
PubMed

Insights

This case study highlights pneumatosis intestinalis, a condition involving gas in the intestinal wall, in a multiple myeloma patient undergoing chemotherapy. The study proposes a novel etiology and successful treatment strategies for this gastrointestinal complication.

Area of Science:

  • Gastroenterology
  • Oncology
  • Internal Medicine

Background:

  • Multiple myeloma (MM) is a hematologic malignancy treated with induction chemotherapy.
  • Chemotherapy can cause various gastrointestinal side effects.
  • Pneumatosis intestinalis is a rare condition characterized by gas within the intestinal wall.

Observation:

  • An elderly male MM patient developed severe watery diarrhea and abdominal pain post-chemotherapy.
  • Imaging revealed intestinal intramural gas, confirmed as pneumatosis intestinalis via colonoscopy.
  • The patient presented with symptoms indicative of a significant gastrointestinal complication.

Findings:

  • Counterperfusion supersaturation is proposed as the underlying mechanism for pneumatosis coli.
  • This mechanism involves disruption of the normal nitrogen and hydrogen balance in the bowel.
  • The patient's condition was successfully managed with conservative treatments.

Implications:

  • Understanding the proposed pathophysiology of pneumatosis intestinalis can guide clinical management.
  • Successful treatment involved antidiarrheal medications, inhaled oxygen, and intravenous hydration.
  • The patient completed MM chemotherapy with a positive response, indicating that this complication can be managed effectively.

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