Pneumatosis coli due to pharmacological constipation - 22/08/11
Doi : 10.1016/j.gie.2006.10.057
| Commentary Pneumatosis intestinalis comes in 2 sorts: cystoides and linearis. Given the choice, it is better to have the former because the latter most often is seen in conditions associated with intestinal necrosis and its presence usually mandates surgery. In pneumatosis cystoides, thin-walled, endothelial-lined cysts may be located in the mucosa, submucosa, and serosa. Typically, the endothelial lining gathers and coalesces, forming multinucleated giant cells as the cyst fibroses and is eventually sloughed. The connective tissue surrounding the cysts may show a granulomatous inflammatory reaction made up of a variety of cells, including eosinophils, lymphocytes, plasma cells, and macrophages. Mucosal changes vary from mild focal abnormalities to extensive changes and include granulomas, abnormal crypt branching, cryptitis, crypt abscesses, and rupture. Constipation is better recognized as a symptom rather than a cause, and other symptoms include diarrhea, abdominal pain, hematochezia, mucorrhea, and urgency. Hematochezia may result from ulceration of the mucosa overlying the cysts, while obstructive symptoms may be caused by cyst encroachment on the lumen or by adhesions formed as the cysts collapse. Benign pneumoperitoneum may occur as subserosal cysts rupture; it may recur or persist, but does not causes peritonitis and does not mandate surgery. This case was nicely diagnosed by colonoscopy, CT, and EUS, and treated appropriately with antibiotics and oxygen. Use of antibiotics recognizes the role bacteria play in producing hydrogen, which accounts for up to 25% of the gas in the cysts, in contrast to the luminal gas content of approximately 14%. Use of oxygen serves to lower the partial pressure of nitrogen and hydrogen in the cyst, thus causing a diffusion gradient for the gases to move out of the cysts and into the surrounding capillaries and tissues. Desiderius Erasmus (1466?-1536) said, “Retain the wind by compressing the belly.” I believe this patient and her bacteria misinterpreted his teachings. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 65 - N° 4
P. 710-711 - avril 2007 Retour au numéro
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