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N Engl J Med 2019 Mar;380(13):e17

Cambridge University Hospitals, Cambridge, United Kingdom

Am Surg 2019 Feb;85(2):e69-e70

Clin Perinatol 2019 03 20;46(1):119-127. Epub 2018 Dec 20.

SPIN Program, San Diego Mothers' Milk Bank, Division of Neonatology, UC San Diego, 9300 Campus Point Drive MC7774, La Jolla, CA 92037, USA; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123. Electronic address:

Current assessment for and diagnosis of necrotizing enterocolitis (NEC) remain inadequate. The introduction of interrogating bowel with ultrasound when NEC is suspected or when NEC has occurred presents greater opportunity to characterize the physical changes that have occurred in the bowel wall structures. The evaluation of bowel by ultrasound has been shown to have high specificity for bowel necrosis. Read More

BMC Surg 2019 Feb 4;19(1):17. Epub 2019 Feb 4.

Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi, China.

Background: Hepatic portal vein gas (HPVG) is a rare acute abdomen, which is not an independent disease. Meanwhile, HPVG combined with appendicitis has been rarely reported. We found only a similar report by looking for literature, but no intestinal necrosis occurred. Read More

BMC Pediatr 2019 Jan 15;19(1):21. Epub 2019 Jan 15.

Department of Pediatric Emergency Medicine, Children's Hospital, China Medical University, Taichung, Taiwan.

Background: Pneumatosis intestinalis and portomesenteric venous gas are usually caused by necrotizing enterocolitis; however they can occur secondary to abusive abdominal trauma with bone fractures and bruising. It is difficult to recognize initially if there is no bruising on the skin or bone fractures.

Case Presentation: We report a 1-year-old child with no obvious history of trauma who presented with conscious disturbance. Read More

Medicine (Baltimore) 2019 Jan;98(2):e14079

Department of Diagnostic Pathology.

Rationale: Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are rare but potentially lethal conditions in which gas pathologically accumulates in the portal vein and intestinal wall, respectively. Proposed mechanisms include flatus escaping through an injured intestinal mucosa into the submucosa and thence into the portal venous system, or bacterial translocation (BT) of gas-forming enteric microorganisms from the gut into and through the intestinal wall to other organs. However, there has been no clear histopathological evidence to support these hypotheses. Read More

Int J Surg Case Rep 2018 9;52:84-88. Epub 2018 Oct 9.

Department of General Surgery, General Hospital of Drama, Drama, Greece.

Introduction: Pneumatosis intestinalis is a rare condition that may be idiopathic or a sign of numerous underlying gastrointestinal, pulmonary and systemic diseases.

Presentation Of Case: Herein, the case an otherwise-healthy 82-year-old female patient with vague abdominal pain due to total colonic pneumatosis 20 days after completion of R-CHOP chemotherapy for a stage IIE primary non-Hodgkin's lymphoma of the terminal ileum submitted to right hemicolectomy and ileal resection 6 months previously is presented. As no evidence of intramural bowel gas was present on pre-operative CT, pneumatosis coli considered to be secondary. Read More

Rev Assoc Med Bras (1992) 2018 Jun;64(6):543-548

Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea.

Objective: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes.

Methods: All CT reports containing the word "pneumatosis" were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63. Read More

Rev Fac Cien Med Univ Nac Cordoba 2018 09 22;75(3):205-211. Epub 2018 Sep 22.

Hospital Nacional de Clínicas - FCM - UNC.

Objective: To present a recent to increase understanding, diagnosis and treatment of intestinal pneumatosis clinical case, considering the distinctive characteristics of the disease and to expand knowledge about the management of this condition.

Methods: The case of a female patient aged 65, originally from Bolivia, with a history of osteoarthritis, osteoporosis, asthma and allergies repetition occurs. The patient was admitted to the Department of Surgery No. Read More

BMJ Case Rep 2018 Sep 28;2018. Epub 2018 Sep 28.

Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia.

Pneumatosis cystoides intestinalis (PCI) refers to the presence of gas within the wall of the small or large intestine. The pathophysiology is incompletely understood and is probably multifactorial in nature. PCI is a known but rare complication of systemic scleroderma, and the aetiology of PCI in patients with scleroderma is not fully understood. Read More

BMJ 2018 Aug 30;362:k2945. Epub 2018 Aug 30.

KSS Deanery.

Case Rep Gastrointest Med 2018 5;2018:6931747. Epub 2018 Aug 5.

Rhode Island Hospital and Brown University, USA.

We present the case of an elderly male patient with known multiple myeloma who was hospitalized with profuse watery diarrhea and abdominal pain after a course of induction chemotherapy. Intestinal intramural gas was found on imaging and the diagnosis of pneumatosis intestinalis was confirmed by colonoscopy. We propose counterperfusion supersaturation as the etiology for this patient's pneumatosis coli via disruption of homeostasis between nitrogen and hydrogen normally present in the bowel. Read More

Cir Cir 2018 ;86(4):370-373

Servicio de Cirugía General y del Aparato Digestivo, Hospital Obispo Polanco, Teruel, España.

Antecedentes: La neumatosis quística intestinal es una condición infrecuente, caracterizada por la formación de quistes de contenido gaseoso debajo de la mucosa y la serosa intestinales.

Caso Clínico: Mujer de 84 años, con antecedente de artritis reumatoide en tratamiento inmunosupresor, intervenida hace 2 años por neumoperitoneo, con diagnóstico de diverticulosis yeyunal y enfisema mesentérico, acude con cuadro de dolor abdominal difuso de 2 días de evolución, sin otra sintomatología. En la radiografía de abdomen se observa neumoperitoneo con elevación del hemidiafragma derecho y distensión de asas del intestino delgado. Read More

BMJ Case Rep 2018 Jul 19;2018. Epub 2018 Jul 19.

Department of Emergency Medicine, Emergency Medicine Research Center (Al-Zahra Research Institute), Isfahan University of Medical Sciences, Isfahan, Iran.

Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that underwent diagnostic surgery and finally diagnosed by midgut malrotation and antral stenosis. Read More

J Trauma Acute Care Surg 2018 07;85(1):33-36

From the Division of Trauma, Critical Care and Emergency Surgery (M.L.C., T.M.D., M.C.-F., B.M.), John Peter Smith Health Network, Fort Worth, Texas; Division of Trauma (N.N.H., M.D.Z., M.D.R.-Z.), Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota; and Division of Trauma and Surgical Critical Care Services (D.D.Y.), University of Miami Miller School of Medicine, Miami, Florida.

Background: Management of small bowel obstruction (SBO) has become more conservative, especially in those patients with previous abdominal surgery (PAS). However, surgical dogma continues to recommend operative exploration for SBO with no PAS. With the increased use of computed tomography imaging resulting in more SBO diagnoses, it is important to reevaluate the role of mandatory operative exploration. Read More

Postgrad Med J 2018 Nov 19;94(1117):665. Epub 2018 Jun 19.

Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Ann Ital Chir 2018 Mar 19;7. Epub 2018 Mar 19.

Cystic intestinal pneumatosis (CIP) is the presence of gas bubbles inside the wall of the intestine. In literature it has been reported to be associated with a variety of clinical conditions such as: superior mesenteric ischemia, intestinal perforation, bowel necrosis, infections which can cause mucosal alterations and therefore increasing its permeability, necrotizing enterocolitis in babies, trauma, intestinal obstruction, autoimmune and pulmonary pathologies. Its presence is usually documented by radiological techniques such as abdominal X-ray, CT scan and endoscopy and are usually characterized by the typical pattern of gas bubbles in the wall of the intestine. Read More

Rev Esp Enferm Dig 2018 Aug;110(8):531-532

Medicina Interna, Hospital Virgen de Altagracia de Manzanares.

Pneumatosis cystoides intestinalis is characterized by multiple air-filled cysts in the intestine wall. A perforation causes pneumoperitoneum, frequently with minimal clinical affectation and do not require surgery at first in most cases. Recently, some cancer treatments, mainly molecular targeted therapy, have been associated with this complication. Read More

Vet Med Sci 2018 05 28;4(2):150-158. Epub 2018 Feb 28.

The University of Minnesota, Veterinary Medical Center Emergency Service, Saint Paul, Minnesota.

To describe a case of naturally occurring pneumatosis intestinalis, pneumatosis coli and emphysematous hepatitis in a cat. A 9-month-old, indoors-only, female spayed, domestic medium hair cat presented for vomiting, open-mouth breathing and acute collapse. The initial physical examination identified moderate to severe hypothermia [35°C (95°F)], obtunded mentation, weak femoral pulses, tachycardia (heart rate 240 beats per min), pale pink mucous membranes and significant splenomegaly on abdominal palpation. Read More

Vet Radiol Ultrasound 2018 May 24. Epub 2018 May 24.

Antech Diagnostics, Framingham, MA, 01702.

An adult cat was presented for acute history of vomiting and collapse. Radiographs showed the presence of air within small intestinal walls and arborizing gas patterns within the liver, compatible with pneumatosis intestinalis and presumed portal venous gas, respectively. An abdominal ultrasound the following day was suggestive of gas within the intestinal wall, however, gas within the hepatic vasculature, parenchyma, or biliary tree was not evident. Read More

Rev Esp Enferm Dig 2018 Jun;110(6):411

Radiodiagnóstico , Hospital General Universitario Morales Meseguer , España.

Pneumatosis intestinalis refers to lineal or cystic gas collections in the intestinal wall. Pneumatosis cystoides intestinalis (PCI) is a benign primary cause. This is a rare disease characterized by multiple gas cysts in the submucosa or subserosa, principally within the colon. Read More

Pediatr Surg Int 2018 May 30;34(5):535-541. Epub 2018 Mar 30.

Department of General surgery and Neonatal surgery, Qilu Children's Hospital affiliated to Shandong University, No. 77 Wenhua west road, Jinan, 250117, Shandong, China.

Purpose: The purpose of this study was to investigate the comparison of AR and AUS in predicting prognosis in infants with necrotizing enterocolitis.

Methods: All patients were diagnosed as NEC at the department of general surgery and neonatal surgery, Qilu children's hospital between 1st, Jun, 2010 and 30th, Dec, 2016. The logistic regression analysis and the area under ROC curve (AUC)s were also used to compare the prognostic values of radiograph and sonograph for NEC. Read More

BMJ Case Rep 2018 Mar 28;2018. Epub 2018 Mar 28.

Department of Neonatology, KK Women's and Children's Hospital, Singapore.

Gastric pneumatosisis a very rare site of pneumatosis intestinalis (PI), and we report this finding in a preterm female infant with cyanotic congenital heart disease. The infant was stable initially on nasal intermittent mandatory ventilation; however, torrential pulmonary flow through a large patent ductus arteriosus prompted closure using oral ibuprofen. After an episode of haematochezia, she developed PI, affecting mainly the gastric wall and small intestine with portal venous gas. Read More

BMJ Case Rep 2018 Mar 23;2018. Epub 2018 Mar 23.

Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.

Semin Ultrasound CT MR 2018 Apr 9;39(2):167-182. Epub 2017 Sep 9.

Grupo Fleury, São Paulo, Brazil; Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil.

Pneumatosis of the alimentary tract may occur from the esophagus to rectum as a result of a wide spectrum of conditions that range from benign to life-threatening. Although distinguishing between these 2 groups is of paramount importance for an appropriate clinical management, it still remains a challenge for the radiologist in the daily practice. In the light of the current literature, we provide in the present article a comprehensive review focusing on the clinical, laboratory, and radiological findings that most consistently may allow such a differentiation. Read More

Acta Gastroenterol Belg 2018 Jan-Mar;81(1):111-112

Department of Gastroenterology, AZ Delta Roeselaere-Menen, Roeselaere.

Intern Med 2018 Jul 28;57(14):1995-1999. Epub 2018 Feb 28.

Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.

A 69-year-old man was admitted to a hospital with complaints of abdominal pain. Computed tomography showed hepatic portal venous gas and pneumatosis cystoides intestinalis. Conservative treatment was effective; however, after discharge, he developed complaints of vomiting. Read More

Saudi J Gastroenterol 2018 Jan-Feb;24(1):69

Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Niigata, Japan.

Diagn Interv Imaging 2018 Mar 9;99(3):123-134. Epub 2018 Feb 9.

Department of Radiology, University Hospitals Paris Nord Val-de-Seine, Beaujon, 92110 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France; Inserm U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, 92110 Paris, France. Electronic address:

Acute mesenteric ischemia is defined as an inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate greater than 95% without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorders (occlusion and/or insufficient blood supply) and features of intestinal ischemic injury. Read More

Gan To Kagaku Ryoho 2017 Nov;44(12):1402-1404

Dept. of Surgery, Fuchu Hospital.

A 47-year-old man underwent hematopoietic stem cell transplantation for malignant lymphoma. He developed acute skin graft versus host disease(GVHD)and pneumomycosis which were treated with steroids. One hundred and fifteen days later, the patient had a diagnosis of free gas images in the abdominal cavity and streakly air collections in the bowel wall from the ascending colon to the sigmoid colon in the CT scan. Read More

J Emerg Med 2018 04 17;54(4):547-548. Epub 2018 Jan 17.

Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, Maine.

Gastroenterology 2018 Feb 18;154(3):e8-e9. Epub 2018 Jan 18.

Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.

Arch Rheumatol 2018 Dec 15;33(4):478-481. Epub 2018 Jan 15.

Department of Surgery, Queen's University, Kingston, Canada.

Connective tissue diseases can be associated with rare gastrointestinal complications such as pneumatosis intestinalis and pneumoperitoneum. In this article, we report a unique case of recurrent pneumatosis intestinalis and spontaneous pneumoperitoneum without evidence of peritonitis in a patient with long-standing mixed connective tissue disease. Computed tomography scan of the abdomen and pelvis revealed pneumatosis of the jejunum and intra-abdominal free air, without evidence of perforation. Read More

G Chir 2017 Sep-Oct;38(5):239-242

Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of multiple gas-filled cysts within the submucosa or subserosa of the intestinal wall. We report a case of PCI in a 54-yearold man 4 weeks after liver transplantation due to hepatitis B virus (HBV)-associated liver cirrhosis presenting with illness, diarrhea and abdominal pain. CT scans revealed normal shape of the abdominal parenchymal organs and no intra-hepatic complication due to liver transplantation. Read More

Rev Esp Enferm Dig 2018 Jan;110(1):68-69

Radiodiagnóstico, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos.

Pneumoperitoneum and cystic intestinal pneumatosis associated to chemotherapy treatment are rare entities, with non-well stablished etiology and controversial management. We report two cases of oncological patients presenting with this complication as incidental finding in CT scan. Their course was favourable under conservative non-surgical approach associated with interruption of chemoterapy treatment. Read More

Pediatr Radiol 2018 05 19;48(5):658-666. Epub 2017 Dec 19.

School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.

Background: Necrotizing enterocolitis (NEC) is a devastating inflammatory disease of the intestinal tract that represents a significant source of morbidity and mortality in preterm infants. Imaging of the abdomen is valuable for timely diagnosis and close monitoring of disease progression in NEC. Bowel ultrasound (US) is increasingly being recognized as an important imaging tool for evaluating NEC that provides additional detail than plain abdominal radiographs. Read More

World J Gastroenterol 2017 Dec;23(45):8090-8096

Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki 57010, Greece.

Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. Read More

J Gastrointestin Liver Dis 2017 12;26(4):337

2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.

BMJ Case Rep 2017 Dec 14;2017. Epub 2017 Dec 14.

Department of General Surgery, Newham University Hospital, London, Plaistow, UK.

N Engl J Med 2017 Dec;377(23):2266

Okayama University Graduate School of Medicine, Okayama, Japan

Clin Case Rep 2017 11 12;5(11):1896-1897. Epub 2017 Sep 12.

Department of Gastroenterology Yokohama City University Graduate School of Medicine Kanagawa Japan.

Pneumatosis cystoides intestinalis is a rare and often presents nonspecific symptoms. In this case, CT imaging revealed air collection within the wall of the ileum, which was more clearly defined using the lung window setting. When we consider pneumatosis cystoides intestinalis, we should evaluate CT using the lung window setting. Read More

BMC Cancer 2017 Nov 9;17(1):732. Epub 2017 Nov 9.

Division of Medical Oncology-Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, (02447) 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea.

Background: Pneumatosis cystoides intestinalis (PCI) is a rare self-limiting condition characterized by air-filled cysts within intestinal walls. Diagnosis should be prudent because it can mimic pneumoperitoneum leading to unnecessary treatment such as surgical exploration. Although various drugs including anti-neoplastic agents have been suggested as etiologies, cases related to sunitinib are sparse. Read More

Exp Clin Transplant 2018 Feb 31;16(1):75-80. Epub 2017 Oct 31.

From the Division of Cardiovascular Surgery, University of Alberta, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.

Objectives: We evaluated the incidence, clinical presentation, laboratory findings, possible causes, and outcomes associated with pneumatosis intestinalis in the setting of lung transplant.

Materials And Methods: A departmental database showed that, between October 2002 and August 2013, our institution performed 373 lung transplants. The database was queried for all patients who had pneumatosis intestinalis and/or pneumoperitoneum after lung transplant at our institution. Read More

Medicina (B Aires) 2017 ;77(5):423

División Terapia Intensiva, Hospital Juan A. Fernández, Buenos Aires, Argentina.

Can Fam Physician 2017 10;63(10):766-768

Assistant Clinical Professor (Adjunct) in the Department of Family Medicine at McMaster University in Hamilton, Ont.

Br J Radiol 2018 Jan 27;91(1081):20170492. Epub 2017 Oct 27.

2 Department of Gastroenterology, Hospital Universitario de la Princesa, Madrid, Spain.

Objective: Review of the experience of a tertiary care centre for almost 10 years in the CT diagnosis of non-occlusive mesenteric ischaemia (NOMI). Analysis of CT findings, correlation with clinical outcomes and evaluation of the usefulness of measuring the superior mesenteric artery (SMA) diameter for the diagnosis of NOMI.

Methods: 106 patients were diagnosed with NOMI in a biphasic CT examination from 2008 to 2017 in our hospital. Read More

Clin J Gastroenterol 2017 Dec 27;10(6):514-518. Epub 2017 Sep 27.

Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.

Non-occlusive mesenteric ischemia (NOMI), which can lead to multifocal and segmental intestinal necrosis without demonstrable occlusion in the main mesenteric artery, is associated with extremely high mortality. Because these intestinal ischemic changes can progress, it is difficult to make a definitive determination intraoperatively as to whether resection of damaged intestine is required. A 62-year-old man who underwent esophagectomy for advanced cervicothoracic esophageal cancer complained of severe abdominal pain on postoperative day 4. Read More

J Med Case Rep 2017 Sep 17;11(1):263. Epub 2017 Sep 17.

Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa, 238-8567, Japan.

Background: Although gastrointestinal involvement in patients with granulomatosis with polyangiitis is uncommon, it is associated with mild to severe life-threatening complications. We present a case of pneumatosis cystoides intestinalis in a patient with granulomatosis with polyangiitis that was treated successfully with hyperbaric oxygen.

Case Presentation: A 70-year-old Japanese man with a 3-year history of granulomatosis with polyangiitis consulted our hospital with a complaint of severe back pain. Read More

European J Pediatr Surg Rep 2017 Jan 31;5(1):e43-e46. Epub 2017 Aug 31.

Department of Surgical Gastroenterology and Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.

 Necrotizing enterocolitis (NEC) is the most frequent surgical emergency in newborns. Intestinal ischemia is considered a factor that precedes the development of NEC lesions. Laser speckle contrast imaging (LSCI) can be used to assess tissue microcirculation. Read More

Am Surg 2017 Aug;83(8):825-831

Pneumatosis intestinalis (PI) identified on computed tomography (CT) suggests an underlying pathology including bowel ischemia. Patients receiving tube feeds can develop PI, potentially requiring surgical intervention. We identify clinical factors in PI to predict those that may be safe to observe versus those that need immediate intervention. Read More