Keam Bhumsuk, Lee Jeong-Hoon, Oh Myoung-Don, Kim Inho, Yoon Sung-Soo, Kim Byoung Kook, Park Seonyang
Department of Internal Medicine, Seoul National University Hospital, College of Medicine, Seoul National University Seoul, Korea.
Korean J Intern Med. 2007 Mar;22(1):40-4. doi: 10.3904/kjim.2007.22.1.40.
Pneumatosis intestinalis (PI) is an uncommon disorder characterized by an accumulation of gas in the bowel wall, and has been associated with a variety of disorders and procedures. We describe a 35-year-old man who undertook hematopoietic stem cell transplantation due to myelodysplastic syndrome. An abdominal X-ray demonstrated extensive PI with pneumoperitoneum mimicking hollow organ perforation. However, the patient had no abdominal symptoms and there was no evidence of peritoneal inflammation. After two weeks of conservative management, including bowel rest and antibiotics, his pneumoperitoneum resolved spontaneously without any complications. Of the many factors that affect the gastrointestinal tract mucosal integrity, intramural pressure, and bacterial flora-produced intraluminal gas interact to produce PI. If the condition is accompanied by bowel ischemia, portomesenteric venous gas, metabolic acidosis, and abdominal sepsis, or if PI is severe in extent immediate surgical intervention is indicated. The described case supports that a mechanical rather than a bacterial etiology underlies the pathogenesis of PI.
肠壁积气症（PI）是一种罕见的疾病，其特征是肠壁内积聚气体，并且与多种疾病和医疗程序有关。我们描述了一名35岁因骨髓增生异常综合征接受造血干细胞移植的男性。腹部X线显示广泛的肠壁积气症并伴有气腹，类似中空器官穿孔。然而，患者没有腹部症状，也没有腹膜炎的证据。经过两周的保守治疗，包括肠道休息和使用抗生素，他的气腹症自发消退，没有出现任何并发症。在影响胃肠道黏膜完整性、壁内压力和细菌菌群产生的腔内气体的众多因素中，它们相互作用会产生肠壁积气症。如果该病症伴有肠缺血、门静脉肠系膜静脉积气、代谢性酸中毒和腹部脓毒症，或者如果肠壁积气症范围严重，则需要立即进行手术干预。所描述的病例支持肠壁积气症发病机制的基础是机械性而非细菌性病因。
