Pneumatosis cystoides intestinalis associated with etoposide in hematological malignancies: a case report and a literature review

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of air collection within the subserosa and/or submucosa of the gastrointestinal wall. Due to the lack of specific symptoms, PCI is likely to be misdiagnosed or missed without the use of imaging techniques or gastrointestinal endoscopy. Here, we report a patient who complained of abdominal distention and constipation after chemotherapy for hematological malignancies, and was diagnosed with secondary PCI via computed tomography (CT) and exploratory laparotomy. Pneumoperitoneum was no longer observed after two weeks of conservative treatments. Notably, the possibility of intra-abdominal pressure (IAP) as a predictor for surgical intervention was proposed. Furthermore, we conducted a literature review on PCI after chemotherapy in hematological malignancies to raise awareness of etoposide-related PCI, while whether PCI could be identified as an adverse event of etoposide requires more evidence.

Keywords: Etoposide; Hematological malignancy; Intra-abdominal pressure; Pneumatosis cystoides intestinalis; Pneumoperitoneum.

Fig. 1

Initial abdominal CT and one week later. Initial abdominal CT scan showed massive free gas collected in the colon wall denoted by the green arrow (b). The gas could even be observed in the mediastinum in the lung view (a) denoted by the red arrow, retroperitoneal space in the abdomen (b) and pelvic cavities view (c) denoted by the yellow arrows. Free accumulated gas was gradually absorbed after one week of conservative treatments in the same view (d–f)

Fig. 2

Intraoperative finding in exploratory laparotomy. Several bright bubbles could be observed within the colon wall with noteworthy crepitus. A bubble was denoted by the red arrow

Fig. 3

Observation of body temperature and inflammatory biomarkers in the following week (d1–d7) after the surgery. Abbreviation: Tmax = the highest body temperature in the day (the green line), WBC white blood cells (the red line), PCT procalcitonin (the orange line), CRP C reaction protein (the blue line)

Fig. 4

IAP was measured based on the trans-bladder technique in the first ten days