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home - Colon - Miscellaneous - Pneumatosis Intestinalis Written by Dr Sebastian Zeki
Methods GMP
Knows the physiology of intestinal absorption, secretion and motility SCE 1
Understands the biochemical processes occurring within the gut
lumen and at mucosal level

Has awareness of the factors controlling these processes – in
particular the neuro-endocrine influences

Understands the range of mechanisms by which diarrhoea can result
from disturbances in each of these processes

Knows the causes of both acute and chronic diarrhoea
Knows the range of investigations appropriate to determining the
cause of the patient’s diarrhoea and is aware of the range of
therapeutic possibilities

Makes a detailed clinical assessment of patients that present with
either acute or chronic diarrhoea

Recognises the potential need for urgent fluid replacement CbD,
Makes appropriate use of microbiology and other relevant laboratories in reaching a diagnosis

Shows ability to interpret results, reach a diagnosis and formulate a
treatment plan

Reacts appropriately to the urgency of the clinical presentation
Always shows sympathy and understanding especially when the
patient is distressed

Pneumatosis Intestinalis

Diagnosis: AXR- Linear, curvilinear, or circular. gas.Linear pneumatosis can be benign esp. when assoc. with bowel infection Endoscopy- Submucosal cysts are pale or bluish. When biopsied, they may rapidly deflate with an audible hiss. Pneumatosis intestinalis (PI) Definition: Presence of gas within the wall of the small or large intestine. Aetiology theories:Mechanical causes-(gas tracking).Bacterial causes-(from within bowel wall) although most cysts are sterile.Biochemical causes (hydrogen gas produced by lumina bacteria forced into the bowel wall.) Submucosal cysts are polypoid with the overlying mucosa displaying a bluish hue. Subserosal cysts are characteristically found near the mesenteric border adjacent to blood vessels and appear as multiple, glistening, pale-bluish, gas-filled blebs AKA: pneumatosis cystoides intestinalis, intramural gas, pneumatosis coli, pseudolipomatosisintestinal emphysema, bullous emphysema of the intestine, and lymphopneumatosis PathologyCan get surrounded by a rim of histiocytes, multinu-clear giant cells, lympho-cytes, neutrophils, eosino-phils, granulomas, and fibrosis, especially after they collapse. The cysts may be confined to the mucosa, submucosa, subserosa, or the cysts may involve all three layers. EpidemiologyIt occurs in 40-70 year olds.It is idiopathic in 15% and secondary in 85%.It is most common in the colon but can occur anywhere. Clinical Features It is usually asymptomatic.Symptomatic patients present in a wide variety of ways.Complications occur in 3%.Complications include-small + large bowel obstruction, volvulus, intussusception, pneumoperitoneum, haemorrhage. TreatmentIf there is nothing to suggest an intra-abdominal emergency then treat conservatively.Inhalation oxygen can be useful -use a FiO2 of 60% to get p02 of 20-30 mmHg for 4-10 days.O2 is toxic to anaerobic intestinal bacteria that contribute to gas cyst formation.High O2 decrease pp of other gases, e.g nitrogen, with a diffusion gradient across cystic wall with exit of cyst gas.Hyperbaric oxygen can be useful as 2.5 atm for 2.5 hours on 2 or 3 consecutive days.Antibiotics such as metronidazole can be given until PI has resolved and this can be used for re-treatment.Ampicillin, tetracycline, and vancomycin have been used successfully.Elemental diet alters the colonic microflora.Surgery is indicated if there is no response to medical therapy.Endoscopic therapy can be used to puncture cysts if visible.Intramural gas cysts usually resolve spontaneously over time.Recurrence occurs in 40% within 18 months. Written by Dr Sebastian Zeki