A systematic analysis of pneumatosis cystoids intestinalis

Abstract

Aim: To increase the understanding, diagnosis and treatment of pneumatosis cystoides intestinalis (PCI) and to find the characteristics and potential cause of the disease in China.

Methods: We report here one case of PCI in a 70-year-old male patient who received a variety of treatment methods. Then, we systematically searched the PCI eligible literature published from an available Chinese database from May 2002 to May 2012, including CBM, CBMDisc, CMCC, VIP, Wanfang, and CNKI. The key words were pneumatosis cystoides intestinalis, pneumatosis, pneumatosis intestinalis, pneumatosis coli and mucosal gas. The patients' information, histories, therapies, courses, and outcomes were reviewed.

Results: The study group consisted of 239 PCI cases (male:female = 2.4:1) from 77 reported incidents. The mean age was 45.3 ± 15.6 years, and the median illness course was 6 mo. One hundred and sixty patients (66.9%) were in high altitude areas. In addition, 43.5% (104/239) of the patients had potential PCI-related disease, and 16.3% had complications with intestinal obstruction and perforation. The most common symptom was abdominal pain (53.9%), followed by diarrhea (53.0%), distention (42.4%), nausea and vomiting (14.3%), bloody stool (12.9%), mucous stool (12.0%) and constipation (7.8%). Most multiple pneumocysts developed in the submucosa of the colon (69.9%). The efficacy of the treatments by combined modalities, surgery, endoscopic treatment, conservative approach, oxygen, and antibiotics were 100%, 100%, 100%, 93.3%, 68.3% and 26.3%, respectively.

Conclusion: PCI can be safely managed by conservative treatments, presents more frequently in males, in the large bowel and submucosa, than in females, in the small intestine and subserosa. High altitude residence maybe associated with the PCI etiology.

Keywords: Colon; Cyst; Intestinal; Pneumatosis; Pneumatosis cystoides intestinalis.

Figure 1

Imaging features of pneumatosis cystoides intestinalis. A: Barium enema study revealing multiple polypoid lesions with air shadows (arrow) and grape-like intramural gas in the whole colon; B: Colonoscopy revealing multiple round and smooth-surfaced elevated lesions (arrow) similar to submucosal tumors in the colon; C: Endoscopic ultrasonography revealing hyperechoic lesions and acoustic shadows in the submucosal layer (arrow); D: Plain radiography of the left upper quadrant abdomen revealing dilatation of the intestine and small linear, round radiolucent areas (arrow) on the clusters in the wall of the colon.

Figure 2

Clinical information of all 217 cases. A: The chief complaints; B: The methods of diagnosis; C: The primary involved site; D: The localization of gas in the intestinal wall. S: Stool; C: Colon; CT: Computed tomography.