Di Pietropaolo Marco, Trinci Margherita, Giangregorio Carlo, Galluzzo Michele, Miele Vittorio
Department of Emergency Radiology, S. Camillo Hospital, Circonvallazione Gianicolense 87, 00152, Rome, Italy.
Department of Radiology, Careggi University Hospital, L. go Giovanni Alessandro Brambilla 3, 50134, Florence, Italy.
Clin J Gastroenterol. 2020 Feb;13(1):31-36. doi: 10.1007/s12328-019-00999-3. Epub 2019 Jun 3.
Pneumatosis intestinalis is the presence of gas in the bowel wall and is divided into two categories: life-threatening pneumatosis intestinalis and benign pneumatosis intestinalis. Pneumatosis cystoides intestinalis is a rare condition characterized by gas-filled cysts in submucosa and subserosa. The pathogenesis is unclear, although some causes have been theorized. The presenting clinical findings may be very heterogeneous. Intestinal pneumatosis may lead to various complications. Distinguishing between pneumatosis cystoides intestinalis and life-threatening pneumatosis intestinalis may be challenging, although computed tomography scan allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of pneumatosis intestinalis. To correctly manage the patients affected with this disease is important to differentiate the two types of pneumatosis. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications. We described a case of a patient with pneumatosis cystoides intestinalis and gastric perforation. The medical history of the patient revealed a breast cancer treated with mastectomy and chemotherapy; the patient did not report a history of gastrointestinal disease. The abdomen CT showed abscess formation at the level of the antro-pylorus, linear pneumatosis in the gastric wall, and free abdominal air. Multiple small air bubbles was observed in intestinal wall. The intestinal wall was not thickened with normal contrast mucosal enhancement. CT examination showed neither mesenteric stranding nor portal venous gas embolism. The findings of the surgery were gastric perforated peptic ulcer and benign pneumatosis intestinalis.
肠壁积气是指肠壁内存在气体，可分为两类：危及生命的肠壁积气和良性肠壁积气。肠壁囊样积气是一种罕见的病症，其特征是黏膜下层和浆膜下层有充满气体的囊肿。尽管已提出一些病因理论，但其发病机制尚不清楚。呈现的临床症状可能非常多样。肠壁积气可能导致各种并发症。区分肠壁囊样积气和危及生命的肠壁积气可能具有挑战性，尽管计算机断层扫描能够检测到其他可能提示肠壁积气潜在、令人担忧的潜在病因的发现。正确治疗受此病影响的患者，区分这两种类型的肠壁积气很重要。肠壁囊样积气患者通常采用保守治疗；手术治疗仅用于并发症。我们描述了一例肠壁囊样积气合并胃穿孔的患者。患者的病史显示曾接受乳房切除术和化疗治疗乳腺癌；患者未报告有胃肠道疾病史。腹部CT显示胃窦 - 幽门水平有脓肿形成，胃壁有线状积气，以及腹腔游离气体。在肠壁观察到多个小气泡。肠壁未增厚，黏膜强化正常。CT检查未显示肠系膜条索状改变或门静脉气体栓塞。手术结果为胃消化性溃疡穿孔和良性肠壁积气。
