Wang Yong Juan, Wang Yu Ming, Zheng Yan Min, Jiang Hui Qing, Zhang Jie
Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Hebei Medical University, Hebei, China.
Department of Gastroenterology and Hepatology, The General Hospital of Tianjin Medical University, Tianjin, China.
BMC Gastroenterol. 2018 Jun 28;18(1):100. doi: 10.1186/s12876-018-0794-y.
Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts in the intestinal submucosa and subserosa. There are few reports of PCI occurring in duodenum and rectum. Here we demonstrated four different endoscopic manifestations of PCI and three cases with intestinal stricture all were successfully managed by medical conservative treatment.
There are 6 cases of PCI with varied causes encountered, in which the etiology, endoscopic features, treatment methods and prognosis of patients were studied. One case was idiopathic, while the other one case was caused by exposing to trichloroethylene (TCE), and the remaining four cases were secondary to diabetes, emphysema, therioma and diseases of immune system. Of the six patients, all complained of abdominal distention or diarrhea, three (50%) reported muco-bloody stools, two (33.3%) complained of abdominal pain. In four other patients, PCI occurred in the colon, especially the sigmoid colon, while in the other two patients, it occurred in duodenum and rectum. Endoscopic findings were divided into bubble-like pattern, grape or beaded circular forms, linear or cobblestone gas formation and irregular forms. After combination of medicine and endoscopic treatment, the symptoms of five patients were relieved, while one patient died of malignant tumors.
PCI endoscopic manifestations were varied, and radiology combined with endoscopy can avoid misdiagnosis. The primary bubble-like pattern can be cured by endoscopic resection, while removal of etiology combined with drug therapy can resolve majority of secondary cases, thereby avoiding the adverse risks of surgery.
肠气囊肿病（PCI）的特征是在肠黏膜下层和浆膜下层出现充满气体的囊肿。十二指肠和直肠发生PCI的报道较少。在此，我们展示了PCI的四种不同内镜表现，并且3例肠道狭窄患者均通过内科保守治疗成功治愈。
共遇到6例病因各异的PCI患者，对患者的病因、内镜特征、治疗方法及预后进行了研究。1例为特发性，另1例由接触三氯乙烯（TCE）引起，其余4例继发于糖尿病、肺气肿、皮样囊肿和免疫系统疾病。6例患者均主诉腹胀或腹泻，3例（50%）报告有黏液血便，2例（33.3%）主诉腹痛。另外4例患者的PCI发生在结肠，尤其是乙状结肠，而另外2例发生在十二指肠和直肠。内镜表现分为气泡样型、葡萄或串珠样环形、线性或鹅卵石样气体形成及不规则型。经药物及内镜治疗联合应用后，5例患者症状缓解，1例患者死于恶性肿瘤。
PCI的内镜表现多样，影像学检查与内镜检查相结合可避免误诊。原发性气泡样型可通过内镜切除治愈，而去除病因联合药物治疗可使大多数继发性病例得到缓解，从而避免手术带来的不良风险。
