From What’s Your Diagnosis? on page 9
The radiologic findings of numerous cystic lucencies within the walls of the colon and multiple round and smooth-surfaced elevated lesions on the sig- moidoscopy are classic for severe pneumatosis cystoids intestinalis (PCI).1 PCI is a rare type of pneumotosis that was first described in the early
1700s and is described pathologically as gas within the
submucosa or subserosa of the intestine. 2 The exact etiology of PCI is not understood fully. Several pathophysio-logic mechanisms have been proposed including primary
intestinal mucosal damage caused by surgical procedures
or percutaneous placement of enteric feeding tubes. Other
proposed causes include underlying malignancy, inflammatory bowel disease, long-term steroid treatment, graft-ver-sus-host disease, infectious disease as well as radiotherapy
and chemotherapy. 2, 3 The exact cause of PCI in our patient
is not entirely known, because multiple replacements of
the gastrojejunostomy were shown consistently by fluoroscopic studies to be within the small bowel.
Patients with PCI can present with minor symptoms, such
as abdominal pain, abdominal distention, nausea, vomiting,
diarrhea, or bloody stool, but can also have more severe
symptoms of intestinal obstruction and perforation. 2 The
majority of PCI cases present as a radiologic finding without
clinically substantial symptoms and are usually managed
conservatively. Surgery should be reserved for cases of sus-
pected bowel obstruction, perforation, or infarction. 2 Our pa-
tient was managed with packed red blood cells transfusions,
and bowel rest without the use of antibiotics. The bleeding
resolved over the next 2 days. A follow-up abdominal radio-
graph before hospital discharge showed minimal improve-
ment of the pneumatosis. An abdominal radiograph done 8
weeks after this hospitalization showed near complete reso-
lution of the PCI radiographic findings. n
1. Ivanovic, A., et al. Gastrointestinal: the role of multidetector computer
tomography in diagnosis of pneumatosis cystoides intestinalis. J Gastroenterol Hepatol. 2012;27:182.
2. Wu, L., et al. A systematic analysis of pneumatosis cystoids intestinalis.
World J Gastroenterol. 2013;19:4973-8.
3. Zulke, C., et al. Acute pneumatosis cystoides intestinalis following allo-geneic transplantation – the surgeon’s dilemma. Bone Marrow Transplant.