Gagliardi G, Thompson I W, Hershman M J, Forbes A, Hawley P R, Talbot I C
Department of Surgery, St. Mark's Hospital, Watford Road, Harrow, UK.
Int J Colorectal Dis. 1996;11(3):111-8. doi: 10.1007/s003840050031.
Pneumatosis coli is a rare condition characterised by multiple gas-filled cysts within the bowel wall. We present 25 cases treated over the past 30 years. The patients' mean age was 59 years: 15 were female. Presenting symptoms included diarrhoea (n = 17), mucus discharge (n = 17), rectal bleeding (n = 15) and constipation (n = 12). Pneumatosis usually affected the left colon (96%), and diagnosis was by sigmoidoscopy and biopsy in 18 cases (72%). Pneumatosis coli was associated with psychiatric disorders (36%), chronic lung disease (20%) and colitis (12%). A redundant sigmoid colon was observed in 80% of cases on contrast radiology. Five patients had mucosal pseudolipomatosis on histological examination. Histological and immunohistochemical review indicated that the cysts were lined by cells of macrophage/monocyte phenotype and that many similar mononuclear cells were present in the adjacent submucosa and overlying mucosa. Treatment with antidiarrhoeals and anti-inflammatory drugs in 14 patients resulted in improvement in 9 cases (64%). Oxygen therapy (n = 9) always alleviated symptoms. There was a high recurrence rate (50-78%), but with further courses of therapy lasting remission was achieved in five patients. Two patients underwent colectomy. The associations of pneumatosis coli with psychiatric disorders and mucosal pseudolipomatosis are new and of possible pathogenetic significance. A novel pathogenetic mechanism is suggested to explain the association of pneumatosis coli and chronic respiratory disorders. A model of pneumatosis coli linking some of the apparently disparate pathogenetic theories is proposed.
结肠积气症是一种罕见疾病，其特征为肠壁内出现多个含气囊肿。我们呈现了过去30年中治疗的25例病例。患者的平均年龄为59岁，其中15例为女性。主要症状包括腹泻（17例）、黏液便（17例）、直肠出血（15例）和便秘（12例）。积气症通常累及左半结肠（96%），18例（72%）通过乙状结肠镜检查及活检确诊。结肠积气症与精神障碍（36%）、慢性肺部疾病（20%）和结肠炎（12%）有关。80%的病例在造影检查中发现乙状结肠冗长。5例患者在组织学检查中发现黏膜假脂肪瘤。组织学和免疫组化检查显示囊肿内衬巨噬细胞/单核细胞表型的细胞，相邻黏膜下层和覆盖黏膜中有许多类似的单核细胞。14例患者使用止泻药和抗炎药治疗，9例（64%）病情改善。吸氧治疗（9例）总能缓解症状。复发率较高（50 - 78%），但通过进一步治疗疗程，5例患者实现了持续缓解。2例患者接受了结肠切除术。结肠积气症与精神障碍和黏膜假脂肪瘤的关联是新发现，可能具有致病学意义。提出了一种新的致病机制来解释结肠积气症与慢性呼吸系统疾病的关联。提出了一个将一些明显不同的致病理论联系起来的结肠积气症模型。
