1. Introduction
In 1783, Johann Georg Du Vernoy described, for the first time, pneumatosis intestinalis (PI), subsequently named Pneumatosis cystoides intestinalis by Mayer in 1825 [1]. PI is a physical or radiographic finding; it suggests the presence of gas in the bowel wall. PI is distributed throughout the digestive tract involving the subserous and/or submucosa of the small and large bowel. The typical location of pneumatosis intestinalis is the descending and sigmoid colon [2].
The true incidence of PI is unknown but the growing use of CT scans has contributed to the increased detection of this radiographic finding [3,4,5].
To date, there are no protocols to guide surgical intervention. Several factors are related to different management approaches to PI [6].
First, the clinical significance of PI can vary from benign findings to pathologic life-threatening bowel ischemia and necrosis [7,8].
Second, the pathogenesis of PI is poorly understood. PI can be the clinical manifestation of several diseases (IBD, especially Crohn’s disease, immune reactions or infections, bacterial abscesses, suppurative cholangitis, and other conditions that may require surgical treatment as bowel obstruction, pseudo-obstruction, malignancies, diverticulitis, and paralytic ileus).
PI has been also related to portal venous gas (PVG), especially in case of intestinal ischemia requiring emergency surgery.
PI and its wide range of clinical manifestations and etiologies represent a challenge for physicians, and especially for surgeons, the choice of the right treatment is not so easy.
The treatment depends on several factors. Suspected etiology and clinical and radiological presentation are the main factors behind the choice of treatment. Treatment can vary from simple drug discontinuation to open abdomen [2,3,4,5].
Literature reports about PI are typically case reports or small case series. Only a few cohort studies with a high number of included patients have been reported.
A systematic review of the literature of the last years was performed to evaluate the factors behind the choice of treatment and the real need for surgery in patients with pneumatosis intestinalis.
2. Methods
Design
An extensive bibliographic search of the literature was performed according to modified PRISMA 2020 guidelines (Figure 1). The study was not registered.
All stages of study selection, data abstraction, and quality assessment were carried out independently by three reviewers (M.G. and A.A.). Any disagreements were resolved by consulting two other reviewers (F.C., G.P.).
Medline and PubMed were consulted in order to identify articles reporting the item “emergency surgery” from January 2010 up to March 2022 and then the Boolean operators “AND” and “OR” were used to mesh it with the following mesh terms: “pneumatosis coli”, “pneumatosis intestinalis”, “acute mesenteric ischemia”. Additional articles were searched by manual identification from the key articles.
We decided to include only papers from 2010 analyzing only a limited period of time. This choice was made to reduce the diagnostic and treatment biases of the past decades related to medical breakthroughs. We aim to take a picture of the etiology, diagnosis, and treatment of PI to understand why and when surgery must be performed or avoided.
Inclusion criteria: pneumatosis intestinalis of the small bowel and large bowel, articles in the English language. In the case of multiple papers from the same group of authors, an effort was made to identify duplicate papers. In the final dataset, every paper on pneumatosis intestinalis (cohort studies, retrospective and prospective studies) is included, also case reports and case series with complete data were included in the paper.
Exclusion criteria: Cases were excluded if the studies reported incomplete data or if the studies were not available in the English language or performed not in humans. Reviews were excluded.
Data relevant to the items of interest were abstracted. Several parameters were recorded and analyzed: gender, mean age, etiology, laboratory tests including cultural exams, symptoms, assessment of hemodynamic status (stable or unstable patients) diagnostic tests (colonoscopy, CT-Scan), location of PI, presence of pneumoperitoneum or portal vein gas (PVG) at diagnosis or delayed, treatment (conservative, surgical) and follow-up. Primary or secondary outcomes were analyzed.
Data analysis was performed using IBM SPSS Statistics 26.0. Univariate and multivariate analyses were performed.
Statistical analysis was obtained for the main descriptive indexes.
Quantitative data are expressed as mean or median ± standard deviation (SD). The qualitative data were elaborated as absolute frequencies, relative frequencies, cumulated frequencies, and percentages.
All factors were deemed to be statically significant at a p-value of less than 5% (p < 0.05).
3. Results
3.1. General Characteristics
After the assessment of abstracts and papers according to the inclusion criteria, 188 articles were included (Figure 1, Table 1).
A total of 1673 patients with pneumatosis intestinalis were included in the study, 773 (46.2%) were males and 581 (34.7%) were females. Gender was not reported in the remaining 319 (19.0%).
The average age was 67.1 ± 17.6 years. PI was related to bowel obstruction in 278 cases (16.6%), large bowel ischemia in 228 cases (13.6%), steroid therapy in 120 cases (7.1%), colonoscopy complications in 64 cases (3.8%), IBD complications in 54 patients (3.2%), monoclonal antibody drugs in 16 cases (0.9%). In 111 cases (6.6%), an underlying disease was found (chemotherapy complications, hyperganglionosis, trauma, sigmoid volvulus, necrotizing pancreatitis), and in 802 (47.9%) patients, the etiology was unknown.
Bacterial etiology was reported only in a few cases. Strongyloides stercoralis and Clostridium difficile were identified in 7 and 3 cases, respectively.
Demographic, pathological features, and etiology are detailed in Table 2 and Table 3.
The most common symptom was abdominal pain with distension in 396 patients (23.6%).
Hemodynamic instability was found in 246 (14.7%) patients.
3.2. Laboratory and Diagnostic Tests
Leukocytosis was observed in 585 patients (34.9%). CRP was documented in less than 207 (12.3%) patients and was elevated only in 61 (29.4%) patients. Elevated lactate level (≥2.0 mmol/L) was found in 359 patients (21.4%).
CT-scan of the abdomen was the most common diagnostic test in 1673 patients (100.0%). Plain X-ray was performed in 459 (27.4%) cases, colonoscopy was performed in 49 cases (2.3%).
PI of the small bowel was the most common site in 610 (36.4%) cases followed by colon and rectum in 497 (29.7%) cases.
The whole colon was involved in 107 (6.3%) patients. In 13 papers (566 patients, 33.8%), the exact location of PI was not reported.
Radiological findings of bowel ischemia (bowel wall thickening, mesenteric stranding, and ascites) were reported in 564 (33.7%) patients. Hepatic portal vein gas (PVG) was identified in 556 (33.2%) patients and pneumoperitoneum was radiologically reported in 301 (17.9%) cases.
3.3. Therapy
Conservative management was the most common treatment in 824 (49.2%) cases. Surgery was performed in 619 (36.9%) patients. Treatment was not reported in 230 (13.7%) cases.
Bowel rest, fluid administration, and antibiotics were the most common conservative treatments in 266 (15.8%) patients.
Every patient with PI related to IBD flare was successfully treated with a high dose of mesalamine and prednisone. PI caused by chemotherapeutic agents, monoclonal antibody drugs, and alpha-glucosidase inhibitors for diabetes were treated successfully with therapy discontinuation in 96 cases (11.7%).
Surgery was performed 619 (36.9%) times. Data about the surgical treatment of 227 (36.6%) patients were not reported.
Among the 619 who underwent surgery, bowel resection was the most common treatment in 237/619 (38.2%) cases.
Laparoscopic/laparotomy exploration without bowel resection was reported in 155 (25.0%) cases (Table 4).
Among the 866 (41.4%) patients with PI and confirmed etiology, 308 (35.5%) underwent surgery. Bowel resection was performed in 149 patients (48.3%) due to organic disease (volvulus, intussusception, Ogilvie’s syndrome, bowel obstruction, etc.). Bowel resection was not necessary in 54 (17.5%) patients. In 105 cases (34.0%), surgical treatment was not specified.
Among the 802 (58.6%) patients with unknown etiology, 311 (38.7%) underwent surgery, Bowel resection was performed in 88 patients (28.2%). Bowel resection was not necessary in 101 (32.4%). In 122 cases (39.2%), surgical treatment was not specified.
Among the 556 (33.2%) patients with PVG, 187 (33.6%) underwent surgery for bowel ischemia, necrosis, or perforation.
Death was reported in 390 (23.3%) cases, and 293 (75.1%) occurred in patients with critical conditions at hospital admission or during the first day after admission, where only supportive therapy was given. A total of 41 (10.5%) deaths were related to other causes. During the follow-up of the 155 cases treated with laparoscopic/laparotomy exploration alone without bowel resection were not reported as deaths.
Surgical management was significantly higher in unstable patients, with bowel ischemia signs, lactate levels greater than 2 mmol/L, and PVG (p = 0.0026).
Hemodynamic instability was reported in 246 patients (14.7%). Data about the clinical status of patients have not been reported in 309 (18.4%) patients.
Hemodynamically unstable patients were significantly associated with bowel ischemia, necrosis, or perforation (p = 0.019).
Higher mortality was significantly related to unstable patients, lactate levels greater than 2 mmol/L, and bowel ischemia signs (p = 0.031) but not with PVG (p > 0.05).
4. Discussion
Pneumatosis intestinalis is a radiological sign that shows several diagnostic and treatment issues.
Treatment can be a lifesaving decision and often the timing for surgical intervention is wrong. Clinical evolution of PI can often be unpredictable, it is responsible for a difficult treatment decision-making process that requires careful evaluation of every variable.
PI can be divided into primary PI (15% of all PI cases) and secondary PI representing 85% of cases. PI can be also divided into pathologic and asymptomatic PI [197].
Secondary PI has been attributed to endoscopic procedures, immunological disturbances, bowel mucosal disruptions, and intra-abdominal pathologies.
Pneumatosis intestinalis is a radiographic phenomenon produced by underlying diseases, which can vary widely. The pattern or extent of PI does not necessarily correlate with the severity of the symptoms or of the underlying disease. The same etiology can lead to both asymptomatic or pathologic PI, the PI severity depends on several factors, but there are no specific findings for pathological and asymptomatic PI [193,195,198,199].
The etiology, both for primary and secondary PI, remains unclear. More than 60 causative diseases and conditions have been identified, but the specific pathophysiology remains unknown [11,16,20,26,127,138,173].
Two pathogenetic hypotheses have been proposed, the mechanical and bacterial theories.
The mechanical theory hypothesizes that gas dissects into the bowel wall from the bowel lumen to some mechanism, causing increased overpressure, such as a bowel obstruction.
The bacterial theory proposes that gas-forming organisms produce gas within the bowel wall, entering the submucosa through mucosal rents or increasing mucosal permeability.
Different laboratory tests (CRP, LDH, and CPK) were reported to be elevated in the case of PI, especially in bowel ischemia, but their role in the diagnosis of pathologic PI is limited because they can be also elevated in systemic inflammatory reactions [47,152,162,192,200].
The patient’s personal history is mandatory in order to discover an underlying cause of PI, as suggested by our results where PI etiology was identified in 52% of the patients (recent endoscopy, diabetes therapy, steroid therapy, IBD, etc.).
Many studies have attempted to create algorithms for PI management. These algorithms may be difficult to apply clinically, especially when the patient requires immediate evaluation. Several studies have investigated the role of risk factors (hypotension, peritonitis, renal failure, serum lactate levels, older age) as predictors of a compromised bowel and the probable need for surgery [5,153,154,193,195,201].
The benign causes of PI usually result in mild or even no abdominal symptoms. In these patients, there are often no CT abnormalities other than the diagnosis of pneumatosis intestinalis.
CT findings can lead to an overtreatment of patients with PI. Portal venous gas has been traditionally associated with bowel necrosis, but our results do not suggest that PVG is always related to bowel ischemia. Among the 556 patients with PVG, 33.6% underwent surgery for bowel ischemia, necrosis, or perforation [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189,190,191,192,193,194,195,196].
Peritoneal symptoms are usually reported in patients with life-threatening causes of PI.
Age ≥ 60 years, white blood cell count of >12, emesis, diarrhea, bloody stools, abdominal pain, constipation, weight loss, and tenesmus have been associated with life-threatening PI [92,202,203,204].
The treatment of pneumatosis intestinalis must focus on the underlying disease rather than on the radiographic sign itself. Surgery could be avoided when a non-organic etiology has been discovered. In this study, bowel resection was performed in 149 patients (48.3%) due to organic disease (volvulus, intussusception, Ogilvie’s syndrome, bowel obstruction, etc.). In 155/392 (39.5%) cases, surgery was performed without the identification of intraoperative pathological findings.
The treatment decision-making should be based on different points of view: the clinical status of patients, the presence of an underlying condition, the need for emergency surgery, and the possibility of simple observation and re-evaluation [103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189,190,191,192,193,194,195,196].
The timing and the decision process are crucial for the patient’s outcome.
The first step remains patient physical examination.
Unstable patients with signs of sepsis and symptoms of shock are most often associated with mesenteric ischemia, bowel necrosis, or bowel obstruction, as suggested by our findings. The outcome for these patients is most unfavorable among patients with PI. Surgical exploration has been performed in almost all cases of instability.
The second step is the identification of an underlying disease that may guide the treatment choice. An accurate anamnesis is fundamental to identifying and treating several diseases or conditions related to PI.
The third step includes the need for surgery. This is the sore point of PI treatment.
When an organic disease has been identified (bowel obstructions, intussusception, or volvulus) surgery remains the main treatment option, and also unstable patients could benefit from surgical exploration.
For stable patients without organic disease, a watchful waiting approach may be more indicated. The possibility of simple observation and re-evaluation should be considered, especially in stable patients with unknown etiology.
Instrumental findings of PVG and massive PI alone in stable patients are not mandatory for surgery. Another approach to stable patients could consist of initial laparoscopic exploration in patients with one or more signs of bowel ischemia or necrosis. Laparoscopy as the first step could avoid unnecessary laparotomy.
5. Conclusions
Our findings suggest and confirm the challenges associated with the appropriate treatment of patients with pneumatosis intestinalis. Many variables should be considered in the approach to patients with pneumatosis intestinalis. The treatment of patients with pneumatosis intestinalis is a lifesaving decision and the timing for surgical intervention is crucial. Accurate personal history of patients is fundamental for the management. Considering the wide range of causes and outcomes of pneumatosis intestinalis, the watch and wait policy as a first step could be reasonable in selected cases.
Surgery remains mandatory in unstable patients and when an organic disease has been identified. Surgical options should be explored, especially laparoscopic exploration in non-responders to conservative management with high suspicion of bowel ischemia and necrosis. It is important to recognize pneumatosis intestinalis as a clinical sign and not as a diagnosis.
Conceptualization, M.G. and G.P.; methodology, M.G.; validation, A.A., F.C., G.F. and E.B.; formal analysis, M.G.; data curation, M.G. and G.L.P.; writing—original draft preparation, M.G.; writing—review and editing, M.G. and G.L.P.; supervision, F.C., E.B., G.F., G.R., V.D. and S.C. All authors have read and agreed to the published version of the manuscript.
Not applicable.
Not applicable.
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
The authors declare no conflict of interest.
PI: Pneumatosis intestinalis; PVG: Portal vein gas.
Footnotes
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Papers included in the literature systematic review.
| References | No. of Patients | Gender | Age | Diagnostic Test | Etiology | Location | Treatment |
|---|---|---|---|---|---|---|---|
| Ling 2019 [ | 1 | M | 64 | CT-Colonoscopy-US | Unknown | Sigmoid Colon | Conservative |
| Gao 2019 [ | 4 | M (3) | 61.2 (Mean) | CT (4) | IBD | Cecum (2) | Conservative |
| Wang | 6 | M (2) | 55.5 (Mean) | CT (4)-Colonoscopy (4)-US (1) | Unknown (2)-glucocorticoid-TCE | Small bowel (1)-sigmoid (2)-descending colon (1)-transverse colon (1)-rectum | Conservative |
| Lee 2017 [ | 1 | F | 68 | CT-Colonoscopy | Sunitinib | Small bowel-cecum | Conservative (Sunitinib suspension) |
| Wu 2013 [ | 1 | M | 70 | CT-US | Unknown | All colon | Conservative |
| Amin 2020 [ | 1 | M | 61 | CT-PET | Unknown | Descending colon | Conservative |
| Göbel 2019 [ | 1 | M | 46 | Colonoscopy-X-ray | Unknown | Ascending Colon | Conservative |
| Smyth 2019 [ | 1 | M | 29 | CT | Steroid therapy | All colon | Conservative |
| Lin 2019 [ | 1 | M | 65 | CT-Colonoscopy | Acarbose | Sigmoid | Conservative (Acarbose suspension) |
| Cuevas 2019 [ | 1 | F | 65 | CT | Unknown | Small bowel-ascending colon | Conservative |
| Kirmanidis 2018 [ | 1 | F | 82 | CT-X-ray | Unknown | All colon | Conservative |
| Asahi 2018 [ | 1 | M | 67 | CT | Sunitinib | Cecum | Conservative (Sunitinib suspension) |
| Vecchio 2018 [ | 1 | M | 86 | CT | Myeloma Therapy | Transverse—descending colon | Conservative |
| Uruga 2018 [ | 1 | F | 71 | CT-X-ray | Erlotinib | All colon | Conservative |
| Akarsu 2018 [ | 1 | M | 65 | CT-Colonoscopy | Unknown | Sigmoid | Conservative |
| Iwamuro 2018 [ | 1 | F | 74 | CT-Colonoscopy | Pseudolipomatosis coli | Cecum-ascending colon | Conservative |
| Cho 2020 [ | 1 | M | 63 | CT-Colonoscopy | Unknown | Sigmoid | Conservative |
| Tharmaradinam 2020 [ | 1 | M | 66 | CT | Hyperganglionosis | Cecum-ascending colon | Right colectomy |
| Toyota 2020 [ | 1 | M | 59 | CT | Decompression Sickness (DCS) | Transverse | Transverse resection-colostomy |
| Tsai 2019 [ | 1 | M | 46 | CT-Colonoscopy | Meningititis | Ascending colon | Exploratory laparoscopy |
| Brighi 2019 [ | 1 | M | 70 | CT | Unknown | All colon | Conservative |
| Tirumanisetty 2019 [ | 1 | F | 75 | CT-X-ray | Unknown | Ascending colon | Right colectomy |
| Lee 2019 [ | 1 | M | 50 | CT | Steroid therapy | - | Conservative |
| Arora 2014 [ | 1 | M | 68 | CT-X-ray | Steroid therapy | - | Conservative |
| Abidali 2018 [ | 1 | F | 60 | CT-Colonoscopy | AAA | Transverse colon | Endovascular AAA repair |
| Poor 2018 [ | 1 | M | 84 | CT | Nintedanib | Cecum | Conservative (Nintedanib suspension) |
| Yamasaki 2019 [ | 1 | F | 63 | CT-Colonoscopy | Unknown | All colon | Conservative |
| Peng 2019 [ | 1 | F | 60 | Colonoscopy | Unknown | Descending colon | Conservative |
| Nukii 2019 [ | 1 | F | 69 | CT | Osimertinib | Transverse colon | Conservative (Osimertinib suspension) |
| Chaundhry 2019 [ | 1 | M | 67 | CT | Bevacizumab | Sigmoid | Conservative (Bevacizumab suspension) |
| González-Olivares 2019 [ | 2 | F (2) | 59 | CT (2) | IBD (2) | Ascending (1) | Conservative (2) |
| Kelly 2018 [ | 1 | F | 59 | CT-X-ray | Unknown | All colon | Conservative |
| Shindo 2018 [ | 1 | M | 81 | CT | Unknown | Small bowel-all colon | Conservative |
| Okuda 2018 [ | 1 | F | 91 | CT | Sigmoid volvulus | Sigmoid | Sigmoid resection-colostomy |
| Liu 2017 [ | 1 | M | 55 | CT-Colonoscopy | Intussusception terminal ileum | Ascending colon | Ileocecal resection |
| Zimmer 2018 [ | 1 | M | 45 | CT-Colonoscopy | Unknown | Transverse colon | Conservative |
| Telegrafo 2017 [ | 1 | M | 54 | CT | Steroid therapy | All colon | Conservative (Steroid suspension) |
| Liang 2018 [ | 1 | F | 66 | Colonoscopy-Barium Enema | Unknown | Descending colon | Left colectomy |
| Ohkuma 2017 [ | 1 | F | 76 | CT | Unknown | Descending colon | Conservative |
| Mikami 2017 [ | 1 | M | 72 | CT-Colonoscopy | Salazosulfapyridine | All colon | Conservative (Salazosulfapyridine suspension) |
| Ribaldone 2017 [ | 1 | F | 59 | CT-Colonoscopy-US | Unknown | Descending colon | Conservative |
| Sugihara 2017 [ | 1 | F | 48 | CT | Unknown | Descending colon | Conservative |
| Robinson 2017 [ | 1 | M | 76 | CT-X-ray | Ogilvie’s syndrome | Ascending colon | Right colectomy-ileostomy |
| Rachapalli 2017 [ | 1 | M | 50 | CT | GVHD | Transverse colon | Conservative |
| Beetz 2019 [ | 1 | M | 60 | CT-Colonoscopy | Steroid therapy | Transverse colon | Conservative (Steroid suspension) |
| Kanwal 2017 [ | 1 | F | 79 | CT-X-ray | Colic perforation | Sigmoid | Left colectomy-colostomy |
| Suzuki 2017 [ | 3 | M (1) | 70.3 | CT (3) | Voglibose (2) | Small bowel (1)-all colon | Conservative (2 voglibose suspension) |
| Tsuji 2017 [ | 1 | M | 51 | CT | Unknown | All colon | Conservative |
| Nishimura 2017 [ | 1 | M | 54 | CT | Unknown | Ascending colon | Conservative |
| Faria 2016 [ | 1 | M | 69 | CT | Chemotherapy | - | Conservative |
| Fujiya 2016 [ | 1 | M | 29 | CT-Colonoscopy | Intussusception | Sigmoid | Intussusception reduction |
| Furihata 2016 [ | 1 | M | 81 | CT-Colonoscopy | Unknown | Sigmoid | Conservative |
| Maeda 2016 [ | 1 | F | 80 | CT-X-ray | Gefitinib | Small bowel-transverse colon | Conservative |
| Fraga 2016 [ | 1 | F | 66 | CT-Colonoscopy | Unknown | Ascending colon | Conservative |
| Gassend 2016 [ | 1 | M | 72 | CT-X-ray | Unknown | All colon | Subtotal colectomy |
| Castren 2016 [ | 1 | F | 74 | CT | Unknown | Small bowel-all colon | Ileostomy |
| Waterland 2016 [ | 1 | M | 76 | CT | GVHD | Ascending colon | Conservative |
| Keklik 2016 [ | 1 | M | 31 | CT | Trauma | Small bowel-all colon | Conservative |
| Ksiadzyna 2016 [ | 1 | M | 64 | CT-Colonoscopy | Acarbose | Ascending-transverse colon | Conservative (Acarbose suspension) |
| Vargas 2016 [ | 1 | M | 65 | CT | 5-FU | All colon | Conservative |
| Ling 2015 [ | 2 | M (1) | 60 | CT (2) | Steroid therapy | Ascending colon (2) | Conservative (2) |
| Rottenstreich 2015 [ | 1 | M | 73 | CT | Acarbose | Small bowel-ascending colon | Conservative (Acarbose suspension) |
| Balasuriya 2018 [ | 1 | M | 32 | CT | Unknown | Ascending colon | Appendicectomy |
| Pülat 2015 [ | 1 | M | 33 | CT-US-EGDS | Unknown | Descending colon | Conservative |
| Helo 2015 [ | 1 | M | 36 | CT-X-ray | Unknown | All colon | Conservative |
| Castro-Poças 2015 [ | 1 | M | 65 | Colonoscopy-US | Unknown | Sigmoid | Conservative |
| Ooi 2015 [ | 1 | M | 44 | CT | Unknown | Descending colon | Hartmann’s procedure |
| Blair 2015 [ | 1 | F | 86 | CT-X-ray | Unknown | All colon | Conservative |
| Chandola 2015 [ | 1 | M | 59 | CT-X-ray | Unknown | Ascending-transverse colon | Conservative |
| Grimm 2015 [ | 1 | M | 21 | CT | Unknown | Ascending colon | Conservative |
| Choi 2014 [ | 1 | F | 74 | CT-X-ray | Unknown | Ascending-transverse colon | Conservative |
| Aziret 2014 [ | 1 | M | 62 | CT-X-ray | Unknown | Small bowel-cecum | Ileocecal resection |
| Rodrigues-Pinto 2014 [ | 1 | M | 67 | Colonoscopy | Unknown | - | Conservative |
| Jacob 2014 [ | 1 | M | 40 | Colonoscopy | Unknown | - | LAR-ileostomy |
| Neesse 2015 [ | 1 | M | 81 | CT-US | Unknown | Ascending colon | Right colectomy |
| Santos-Antunes 2014 [ | 1 | M | 73 | Colonoscopy | Unknown | Ascending colon | Conservative |
| Martis 2014 [ | 1 | F | 77 | CT | Unknown | Descending colon | Conservative |
| Krüger 2014 [ | 1 | M | 54 | CT-US | Unknown | - | Conservative |
| Tseng 2014 [ | 1 | F | 50 | CT-X-ray | Unknown | Ascending colon | Conservative |
| Rajpal 2014 [ | 1 | F | 56 | CT-X-ray | Unknown | Ascending colon | Colic resection |
| Bamakhrama 2014 [ | 1 | F | 85 | CT-colonoscopy-US | Unknown | Descending colon | Conservative |
| Chao 2014 [ | 1 | F | 40 | CT | Unknown | Small bowel | Conservative |
| Jurado-Romàn 2014 [ | 1 | M | 87 | CT | Unknown | Small bowel | Conservative |
| Pinto Pais 2014 [ | 1 | F | 43 | CT-US | Unknown | Small bowel-cecum | Conservative |
| Lemos 2014 [ | 1 | F | 39 | CT-colonoscopy-X-ray | Appendicitis | Cecum-ascending colon | Right colectomy |
| Qin 2014 [ | 1 | M | 29 | CT-colonoscopy | Colonoscopy complication | Ascending-transverse colon | Conservative |
| Lim 2014 [ | 1 | F | 28 | CT-X-ray | Unknown | - | Conservative |
| Nakajima 2013 [ | 1 | M | 52 | CT-X-ray | Steroid therapy | - | Conservative |
| Bareggi 2014 [ | 1 | F | 32 | CT | Unknown | - | Conservative |
| Fong 2014 [ | 1 | M | 85 | CT-colonoscopy-X-ray | Sigmoid cancer | Ascending colon | Endoscopic stent |
| Zarbalian 2013 [ | 1 | F | 51 | CT | Steroid therapy | - | Right colectomy |
| Lommen 2020 [ | 1 | F | 65 | Colonoscopy-barium enema | Unknown | All colon | Conservative |
| Ezuka 2013 [ | 1 | F | 62 | CT | Steroid therapy | Ascending colon | Conservative |
| Siddiqui 2013 [ | 1 | M | 35 | CT-X-ray | Pancreatitis | Ascending colon | Conservative |
| Tanabe 2013 [ | 1 | F | 80 | CT-X-ray | Alpha-Glucosidasy Inhibitor | - | Conservative (Alpha-Glucosidasy Inhibitor suspension) |
| Adar 2013 [ | 1 | M | 63 | CT-colonoscopy- | Unknown | Descending colon | Alpha-Glucosidasy Inhibitor |
| Rahim 2013 [ | 1 | M | 39 | CT | Steroid therapy | Cecum | Right colectomy |
| Liang 2013 [ | 1 | M | 88 | CT | Unknown | Cecum-ascending colon | Conservative |
| Ponz de Leon 2013 [ | 1 | M | 54 | Colonoscopy | Unknown | All colon | Total colectomy (FAP) |
| Mourra 2013 [ | 1 | M | 50 | Colonoscopy | Unknown | All colon | Total colectomy (FAP) |
| Masuda 2013 [ | 1 | F | 68 | Colonoscopy | Unknown | Ascending colon | Conservative |
| Kashima 2012 [ | 1 | F | 77 | CT | Sorafenib | Unknown | None (death) |
| Aitken 2012 [ | 1 | F | 69 | CT | Unknown | All colon | None (death) |
| Makni 2012 [ | 1 | M | 56 | CT-X-ray | Unknown | Unknown | Conservative |
| Balbir-Gurman 2012 [ | 1 | F | 76 | CT-X-ray | Unknown | Sigmoid | Conservative |
| Schieber 2012 [ | 1 | F | 19 | CT-colonoscopy | IBD | Cecum-ascending colon | Conservative |
| Lee | 1 | F | 66 | CT-X-ray | Gefitinib | All colon | Conservative (Gefitinib suspension) |
| Vijayakanthan 2012 [ | 2 | M (2) | 27.5 | CT-X-ray | Imatinib | Cecum (1)-Transverse colon | Conservative (Imatinib suspension) |
| Chang 2012 [ | 1 | M | 85 | CT-X-ray | Bowel Ischemia | Ascending colon | None (death) |
| Martin-Smith 2011 [ | 1 | M | 34 | CT | Necrotizing pancreatitis | Cecum-ascending colon | Conservative |
| Hong 2012 [ | 1 | F | 75 | CT | Unknown | Ascending colon | Laparoscopic exploration (ileostomy) |
| Hoot 2013 [ | 1 | F | 57 | CT | Trauma | Ascending-transverse-sigmoid colon | Conservative |
| Shimada 2011 [ | 1 | M | 43 | CT | Unknown | Cecum-ascending colon | Conservative |
| Iwasaku 2012 [ | 1 | F | 82 | CT | Gefitinib | Ascending colon | Conservative (Gefitinib suspension) |
| Nancy 2013 [ | 1 | M | 22 | CT | Colonoscopy complication | Ascending-transverse colon | Conservative |
| Sagara 2012 [ | 2 | F (2) | 48.5 | CT (2) | Steroid therapy (1) | Sigmoid (1) | Colostomy (1)- |
| Jarkowski 2011 [ | 1 | M | 73 | CT | Sunitinib | Ascending-transverse colon | Conservative (Sunitinib suspension) |
| Wu 2011 [ | 1 | F | 67 | CT-colonoscopy | Alpha-Glucosidasy Inhibitor | Ascending colon | Conservative (Alpha-Glucosidasy Inhibitor suspension) |
| Yoon 2011 [ | 3 | M (1) | 59.6 | CT (3) | Cetuximab | Cecum (2)-ascending (2)-transverse colon (2) | Conservative (Cetuximab suspension) |
| Lioger 2012 [ | 1 | M | 67 | CT | Collagen Disorders | Unknown | Unknown |
| Arenal 2011 [ | 1 | F | 18 | CT | Unknown | Cecum | Conservative |
| Amrein 2011 [ | 2 | M (1) | 61.5 | CT-colonoscopy | Unknown | Ascending colon (2) | Right colectomy (1) |
| García-Castellanos 2011 [ | 1 | F | 32 | CT-colonoscopy | Unknown | Descending-sigmoid colon-rectum | Left colectomy |
| Strote 2012 [ | 1 | M | 57 | CT-US | Unknown | Ascending colon | Small Bowel Resection-Superior Mesentery Artery Thrombectomy |
| Kim 2011 [ | 1 | F | 40 | CT-colonoscopy | Unknown | Sigmoid | Conservative |
| Shimojima 2011 [ | 1 | M | 48 | CT-X-ray | Glimepiride Voglibose | Ascending colon | Conservative (Glimepiride Voglibose suspension) |
| Wright 2011 [ | 1 | F | 42 | CT-X-ray | Unknown | Cecum | Conservative |
| Marinello 2010 [ | 1 | M | 20 | CT | LES | Unknown | Conservative |
| Pasquier 2011 [ | 1 | F | 96 | CT | Unknown | Unknown | Conservative |
| Bamba 2010 [ | 2 | M (1) | 43.5 | CT-colonoscopy-X-ray (1) | Colonoscopy complication | Cecum (1)-ascending (1)-transverse colon (1) | Conservative |
| Huang 2010 [ | 1 | M | 30 | CT-X-ray | Transplantation complication | Ascending colon | Conservative |
| Liao 2010 [ | 1 | M | 48 | CT-US | Colonic trauma | Ascending colon | Right colectomy |
| Chaput 2010 [ | 1 | M | 57 | Colonoscopy-X-ray-Manometry | Unknown | Rectum | Conservative |
| Ong 2010 [ | 1 | M | 69 | CT-X-ray | Volvulus | All colon | Total colectomy |
| Newman 2010 [ | 1 | M | 26 | CT-X-ray | GVHD | Unknown | Conservative |
| Syed 2020 [ | 1 | M | 60 | CT-colonoscopy | Clindamycin | Sigmoid | Conservative |
| Meini 2020 [ | 1 | M | 44 | CT | COVID-19 | Ascending colon | Conservative |
| Miwa 2020 [ | 1 | M | 58 | CT-colonoscopy | Unknown | Ascending-transverse colon | Conservative |
| Kielty 2020 [ | 1 | M | 47 | CT | COVID-19 | Small bowel-cecum | Conservative |
| Lakshmanan 2020 [ | 1 | M | 72 | CT | COVID-19 | Ascending-sigmoid colon | Conservative |
| Hokama 2020 [ | 1 | M | 91 | CT | Strongyloides Stercoralis | Small bowel-all colon | Conservative |
| Wang 2020 [ | 2 | M (2) | 90 | CT | Unknown | Small bowel-all colon | Conservative |
| Ribolla 2020 [ | 1 | F | 65 | CT | Unknown | Ascending colon | Laparotomy exploration |
| Zhang 2012 [ | 1 | M | 60 | CT | IBD | Transverse-descending-sigmoid colon | Conservative |
| Ferrada 2017 [ | 127 | - | 57 | CT (117)-X-ray (8) | Unknown | Small bowel (61)-cecum (40)-ascending (60)-transverse (17)-descending colon (12)-sigmoid (11)-rectum (3) | Surgery (70) |
| Matsumoto 2016 [ | 70 | M (38) | 72 (Mean) | CT (70) | Unknown | Small bowel (42)-ascending (20)-descending colon (8) | Surgery (39) |
| Bani 2013 [ | 209 | - | 56.8 (Mean) | CT (209) | Obstruction (53)- | Unknown | Surgery |
| DuBose 2013 [ | 500 | M (283) | 56.6 | CT (500) | IBD (18)- | Small bowel (305)-colon (285)-rectum (3) | Surgery (199) |
| Gupta 2020 [ | 1 | F | 81 | CT | Unknown | Small bowel | Conservative |
| Muhammad Nawawi 2020 [ | 1 | M | 38 | CT | Unknown | Small bowel | Conservative |
| Gomes 2020 [ | 1 | F | 90 | CT | Sigmoid cancer | Small bowel | Surgery |
| Takimoto 2020 [ | 1 | F | 75 | CT | M. avium-amyloidosis | Colon | Conservative |
| Lim 2020 [ | 1 | M | 68 | CT | Unknown | Small bowel | Surgery |
| Fairley 2020 [ | 1 | M | 71 | CT | Colonoscopy complication | Colon | Conservative |
| Molina 2020 [ | 1 | F | 72 | CT-X-ray | Unknown | Small bowel | Surgery |
| Arai 2020 [ | 25 | M (17) | 75 (Mean) | CT | Unknown | Colon-Small bowel | Surgery (17) |
| Police 2020 [ | 1 | M | 72 | CT | Sigmoid volvulus | Sigmoid colon | Surgery (Sigmoidectomy) |
| Wheatley 2020 [ | 1 | F | 52 | CT | Unknown | Small bowel | Surgery |
| Tsang 2019 [ | 2 | M (1) | 67.5 (Mean) | CT (2) | Unknown | Small bowel-ascending colon | Surgery (1) |
| Chen 2019 [ | 1 | M | 63 | CT-US | Unknown | Small bowel | Surgery |
| Kim 2019 [ | 2 | M (2) | 75.5 (Mean) | CT | Cardiac surgery | Small bowel | Suergery (2) |
| Furutani 2019 [ | 1 | M | 69 | CT | Colic resection | Ascending colon | Conservative |
| Varelas 2019 [ | 11 | M (9) | 61 (Mean) | CT | Lactulose (9) | Small bowel (1)-colon (11) | Surgery (2) |
| Arai 2019 [ | 1 | M | 51 | CT | Unknown | Small bowel | Surgery |
| Belkhir 2019 [ | 1 | M | 28 | CT-US | Unknown | Small bowel | Surgery |
| Khan 2019 [ | 1 | F | 70 | CT | Capecitabine | Small bowel | Surgery |
| Di Pietropaolo 2019 [ | 1 | F | 78 | CT | Chemotherapy | Small bowel-ascending colon | Surgery |
| Perez Rivera 2019 [ | 1 | M | 19 | CT | Previous gastrostomy | Small bowel-colon | Conservative |
| Ibrahim 2019 [ | 1 | M | 69 | CT | Unknown | Small bowel | Surgery |
| Harris 2019 [ | 1 | F | 57 | CT-X-ray | Jejunal lymphangioma | Small bower | Surgery |
| Bansal 2019 [ | 1 | M | 52 | CT | Unknown | Small bowel | Surgery |
| Dhadlie 2018 [ | 2 | M (2) | 80.5 | CT (1)-X-ray (1) | Unknown | Small bowel | Surgery (1) |
| Sanford 2018 [ | 4 | M (2) | 77 | CT (4) | Unknown | Small bowel (2)-cecum (2)-ascending-sigmoid colon | Surgery (3) |
| Guan 2018 [ | 1 | F | 78 | CT | Systemic sclerosis | Small bowel-colon | Surgery |
| Gray 2018 [ | 1 | F | 64 | CT | Unknown | Small bowel | Surgery |
| Fujimi 2016 [ | 1 | M | 55 | CT | Nilotinib | Small bowel | Conservative |
| Yamamamoto 2020 [ | 1 | F | 70 | CT-colonoscopy | Unknown | Ascending colon | Conservative |
| Dibra 2020 [ | 1 | F | 60 | CT-X-ray | Unknown | Small bowel | Surgery |
| Fukunaga 2022 [ | 1 | F | 81 | CT | Cardiac surgery | Small bowel | Surgery |
| Furtado 2022 [ | 1 | F | 81 | CT | Unknown | Small Bowel | Conservative |
| Sharp 2022 [ | 1 | M | 61 | CT-X-ray | Pseudomonas aeruginosa | Small bowel | Conservative |
| Gefen 2022 [ | 1 | M | 40 | CT-X-ray | Steroid therapy | Ascending colon | Surgery |
| Yadzi 2021 [ | 1 | M | 30 | CT | Ileal volvulus | Small bowel | Surgery |
| Yeo 2021 [ | 2 | M | 71.5 (Mean) | CT-X-ray | Steroid therapy | Small bowel | Surgery (1) |
| Brocchi 2021 [ | 8 | M (5) | 65.5 (Mean) | CT | Chemotherapy | Small bowel (2) | Surgery |
| Yamamoto 2021 [ | 1 | M | 43 | CT | Steroid therapy | Colon | Conservative |
| Della seta 2021 [ | 290 | M (171) | 66.7 (Mean) | CT | Obstruction (110) | Unknown | Surgery (155) |
| Adachi 2020 [ | 21 | M (12) | 80.1 (Mean) | CT | Steroid therapy (3) | Small bowel (12) | Conservative |
| Epin 2022 [ | 58 | M (37) | 72.0 | CT | Unknown | Small Bowel | Surgery (25) |
| Treyaud 2017 [ | 149 | M (96) | 64.0 | CT | Obstruction (10) | Small Bowel (72) | Surgery (51) |
Demographic and pathological features of the studied population.
| Parameters | Analyzed Variable | No, % | Mean ± SD |
|---|---|---|---|
| Sex | Female | 581, 34.7% | |
| Male | 773, 46.2% | ||
| Not reported | 319, 19.0% | ||
| Mean age (years) | All considered patients | 67.1 ± 17.6 | |
| Etiology | Known | 871, 52.0% | |
| Unknown | 802, 47.9% | ||
| Diagnostic findings | Signs of bowel ischemia | 564, 33.7% | |
| Portal vein gas | 556, 33.2% | ||
| Pneumoperitoneum | 301, 17,9% |
SD: Standard deviation.
Etiology of Pneumatosis Intestinalis.
| Etiology | (No. of Patients, % *) |
|---|---|
| Bowel Obstruction | 278, 16.6% |
| Steroid Therapy | 120, 7.1% |
| Colonoscopy Complications | 64, 3.8% |
| Large Bowel Ischemia | 228, 13.6% |
| IBD complications | 54, 3.2% |
| Monoclonal Antibody Drugs | 16, 0.9% |
| Other | 68, 4.0% |
| Unknown | 802, 47.9% |
| Total PI | 1673, 100% |
PI: Pneumatosis Intestinalis. * Percentage refers to the total of patients for respective etiology.
Therapy.
| Therapeutic Approach | No (1673), 100% * |
|---|---|
| NOM | 824, 49.2% |
| Drugs discontinuation | 96, 11.7% |
| Antibiotics-TPN | 166, 20.1% |
| IBD therapy | 54, 6.5% |
| NR NOM | 508, 61.6% |
| Surgery | 619, 36.9% |
| Bowel resection | 237, 38.2% |
| Laparoscopic/Laparotomy exploration (no resections) | 155, 25.0% |
| NR Surgical treatment | 227, 36.6% |
| NR | 230, 13.7% |
NOM: Non-operative management. NR: Not reported. * The % refers to the total patients of NOM and Surgery procedures.
References
1. Du Vernoy, J.G. Aer intestinorum tam sub extima quam intimatunica inclusus: Observationes anatomicae: Comment. Acad. Acient Imp. Petropol.; 1730; 5, pp. 213-225.
2. Wu, L.L.; Yang, Y.S.; Dou, Y.; Liu, Q.S. A systematic analysis of pneumatosis cystoids intestinalis. World J. Gastroenterol.; 2013; 19, pp. 4973-4978. [DOI: https://dx.doi.org/10.3748/wjg.v19.i30.4973]
3. Barmase, M.; Kang, M.; Wig, J.; Kochhar, R.; Gupta, R.; Khandelwal, N. Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. Eur. J. Radiol.; 2011; 80, pp. e582-e587. [DOI: https://dx.doi.org/10.1016/j.ejrad.2011.09.015] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21993179]
4. Duron, V.P.; Rutigliano, S.; Machan, J.T.; Dupuy, D.E.; Mazzaglia, P.J. Computed tomographic diagnosis of pneumatosis intestinalis: Clinical measures predictive of the need for surgical intervention. Arch. Surg.; 2011; 146, pp. 506-510. [DOI: https://dx.doi.org/10.1001/archsurg.2011.95] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21576602]
5. Pickhardt, P.J.; Kim, D.H.; Taylor, A.J. Asymptomatic pneumatosis at CT colonography: A benign self-limited imaging finding distinct from perforation. AJR Am. J. Roentgenol.; 2008; 190, pp. W112-W117. [DOI: https://dx.doi.org/10.2214/AJR.07.2843]
6. DuBose, J.J.; Lissauer, M.; Maung, A.A.; Piper, G.L.; O’Callaghan, T.A.; Luo-Owen, X.; Inaba, K.; Okoye, O.; Shestopalov, A.; Fielder, W.D. et al. Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): A multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J. Trauma Acute Care Surg.; 2013; 75, pp. 15-23. [DOI: https://dx.doi.org/10.1097/TA.0b013e318298486e]
7. Ho, L.M.; Paulson, E.K.; Thompson, W.M. Pneumatosis intestinalis in the adult: Benign to life-threatening causes. AJR Am. J. Roentgenol.; 2007; 188, pp. 1604-1613. [DOI: https://dx.doi.org/10.2214/AJR.06.1309]
8. Knechtle, S.J.; Davidoff, A.M.; Rice, R.P. Pneumatosis intestinalis. Surgical management and clinical outcome. Ann. Surg.; 1990; 212, pp. 160-165. [DOI: https://dx.doi.org/10.1097/00000658-199008000-00008]
9. Ling, F.; Guo, D.; Zhu, L. Pneumatosis cystoides intestinalis: A case report and literature review. BMC Gastroenterol.; 2019; 19, 176. [DOI: https://dx.doi.org/10.1186/s12876-019-1087-9]
10. Gao, Y.; Uffenheimer, M.; Ashamallah, M.; Grimaldi, G.; Swaminath, A.; Sultan, K. Presentation and outcomes among inflammatory bowel disease patients with concurrent pneumatosis intestinalis: A case series and systematic review. Intest. Res.; 2020; 18, pp. 289-296. [DOI: https://dx.doi.org/10.5217/ir.2019.00073]
11. Wang, Y.J.; Wang, Y.M.; Zheng, Y.M.; Jiang, H.Q.; Zhang, J. Pneumatosis cystoides intestinalis: Six case reports and a review of the literature. BMC Gastroenterol.; 2018; 18, 100. [DOI: https://dx.doi.org/10.1186/s12876-018-0794-y] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29954324]
12. Lee, Y.S.; Han, J.J.; Kim, S.Y.; Maeng, C.H. Pneumatosis cystoides intestinalis associated with sunitinib and a literature review. BMC Cancer.; 2017; 17, 732. [DOI: https://dx.doi.org/10.1186/s12885-017-3744-0]
13. Amin, S.; Dorer, R.; Irani, S. Full-thickness resection of subepithelial nodules, allowing for the diagnosis of an unusual case of pneumatosis cystoides intestinalis. VideoGIE; 2020; 5, pp. 120-122. [DOI: https://dx.doi.org/10.1016/j.vgie.2019.12.003]
14. Göbel, T.; Donnez, E. Pneumatosis Cystoides Intestinalis as an Incidental Finding on Endoscopy. Dtsch. Ärzteblatt Int.; 2019; 116, 496. [DOI: https://dx.doi.org/10.3238/arztebl.2019.0496] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31452500]
15. Smyth, A.I.; Osmanska, J.; Lip, S.; Chong, P.S.; Dalzell, J.R. An unusual gastrointestinal complication following heart transplantation. Ulst. Med. J.; 2019; 88, 56.
16. Lin, W.C.; Wang, K.C. Pneumatosis Cystoides Intestinalis Secondary to Use of an α-Glucosidase Inhibitor. Radiology; 2019; 290, 619. [DOI: https://dx.doi.org/10.1148/radiol.2019182186] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30644816]
17. Cuevas-Castillejos, J.E.; Valdovinos-Díaz, M.A. Pneumatosis cystoides intestinalis: A rare benign cause of chronic pain and bloating with pneumoperitoneum. Neumatosis quística intestinal: Una causa rara y benigna de dolor y distensión abdominal crónicos con neumoperitoneo. Rev. Gastroenterol. Mex.; 2019; 84, pp. 402-404. [DOI: https://dx.doi.org/10.1016/j.rgmx.2018.11.003]
18. Kirmanidis, M.; Boulas, K.; Paraskeva, A.; Kariotis, I.; Barettas, N.; Kariotis, S.; Keskinis, C.; Hatzigeorgiadis, A. Extensive colonic pneumatosis in a patient on adjuvant chemotherapy after right colectomy for primary terminal ileum lymphoma: A decision-making process between surgical and non-surgical management. Int. J. Surg. Case Rep.; 2018; 52, pp. 84-88. [DOI: https://dx.doi.org/10.1016/j.ijscr.2018.09.050]
19. Asahi, Y.; Suzuki, T.; Sawada, A.; Kina, M.; Takada, J.; Gotoda, H.; Masuko, H. Pneumatosis Cystoides Intestinalis Secondary to Sunitinib Treatment for Gastrointestinal Stromal Tumor. Case Rep. Gastroenterol.; 2018; 12, pp. 432-438. [DOI: https://dx.doi.org/10.1159/000490657]
20. Vecchio, E.; Jamot, S.; Ferreira, J. Pneumatosis Coli Formation via Counterperfusion Supersaturation in a Patient with Severe Diarrhea. Case Rep. Gastrointest. Med.; 2018; 2018, pp. 1-4. [DOI: https://dx.doi.org/10.1155/2018/6931747]
21. Uruga, H.; Moriguchi, S.; Takahashi, Y.; Ogawa, K.; Murase, K.; Mochizuki, S.; Hanada, S.; Takaya, H.; Miyamoto, A.; Morokawa, N. et al. Gefitinib successfully administered in a lung cancer patient with leptomeningeal carcinomatosis after erlotinib-induced pneumatosis intestinalis. BMC Cancer; 2018; 18, 825. [DOI: https://dx.doi.org/10.1186/s12885-018-4743-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30115025]
22. Akarsu, M.; Duran, Y.; Htway, Z. A pneumatosis intestinalis case diagnosed with water-immersion technique. Endoscopy; 2018; 50, pp. E267-E268. [DOI: https://dx.doi.org/10.1055/a-0640-2527] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29969796]
23. Iwamuro, M.; Tanaka, T.; Kawabata, T.; Sugihara, Y.; Harada, K.; Hiraoka, S.; Okada, H. Pseudolipomatosis of the Colon and Cecum Followed by Pneumatosis Intestinalis. Intern. Med.; 2018; 57, pp. 2501-2504. [DOI: https://dx.doi.org/10.2169/internalmedicine.0730-17] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29709952]
24. Cho, Y.M.; Behrenbruch, C.; Smart, P. Colonic lymphoma or pneumatosis coli: Should I biopsy?. ANZ J. Surg.; 2020; 90, pp. 1198-1200. [DOI: https://dx.doi.org/10.1111/ans.15511]
25. Tharmaradinam, S.; Kanthan, S.; Kanthan, R. Pneumatosis cystoides intestinalis and hyperganglionosis—Cause or effect? A review. Pathol. Res. Pr.; 2020; 216, 152879. [DOI: https://dx.doi.org/10.1016/j.prp.2020.152879]
26. Toyota, S.; Nagata, S.; Yoshino, S.; Kono, S.; Kawanami, S.; Maeda, S.; Kuramitsu, E.; Ichimannda, M.; Nagamatsu, S.; Kai, S. et al. Mesenteric venous thrombosis as a rare complication of decompression sickness. Surg. Case Rep.; 2020; 6, pp. 1-5. [DOI: https://dx.doi.org/10.1186/s40792-020-0780-9]
27. Tsai, N.Y.; Chou, C.H.; Cheng, Y.C. Pneumatosis cystoides intestinalis in a patient with aseptic meningitis: A case report. Int. J. Color. Dis.; 2019; 34, pp. 1805-1808. [DOI: https://dx.doi.org/10.1007/s00384-019-03383-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31471694]
28. Brighi, M.; Vaccari, S.; Lauro, A.; D’andrea, V.; Pagano, N.; Marino, I.R.; Cervellera, M.; Tonini, V. “Cystamatic” Review: Is Surgery Mandatory for Pneumatosis Cystoides Intestinalis?. Dig. Dis. Sci.; 2019; 64, pp. 2769-2775. [DOI: https://dx.doi.org/10.1007/s10620-019-05767-4]
29. Tirumanisetty, P.; Sotelo, J.W.; Disalle, M.; Sharma, M. Pneumatosis intestinalis: Cost paid for rheumatoid arthritis treatment. BMJ Case Rep.; 2019; 12, e229329. [DOI: https://dx.doi.org/10.1136/bcr-2019-229329]
30. Lee, C.I.; Wu, Y.H. Pneumatosis intestinalis and pneumoretroperitoneum post steroid use in a patient with superior mesenteric artery syndrome. Am. J. Emerg. Med.; 2019; 37, pp. 1993.e1-1993.e3. [DOI: https://dx.doi.org/10.1016/j.ajem.2019.06.040]
31. Arora, A.; Jouhra, F. Pneumatosis cystoides intestinalis with pneumoperitoneum in a renal transplant patient. Br. J. Hosp. Med.; 2014; 75, 407. [DOI: https://dx.doi.org/10.12968/hmed.2014.75.7.407] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25040522]
32. Abidali, H.; Cole, L.; Seetharam, A.B. Rapid reversal of colonic pneumatosis with restoration of mesenteric arterial supply. Clin. J. Gastroenterol.; 2018; 11, pp. 461-464. [DOI: https://dx.doi.org/10.1007/s12328-018-0872-2] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29881954]
33. Poor, A.; Braman, S.S. Pneumatosis Intestinalis Associated with the Tyrosine Kinase Inhibitor Nintedanib. Lung; 2018; 196, pp. 373-375. [DOI: https://dx.doi.org/10.1007/s00408-018-0118-6] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29721603]
34. Yamasaki, M.; Teshima, H.; Okanobu, H.; Hattori, N. Pneumatosis cystoides intestinalis in pulmonary mycobacterial disease. Br. J. Hosp. Med.; 2019; 80, iii. [DOI: https://dx.doi.org/10.12968/hmed.2019.80.6.iii] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31180773]
35. Peng, F.B.; Kim, H.S.; Agarwal, S.K. Abnormal Polypoid Finding During Colonoscopy. Gastroenterology; 2019; 157, pp. 940-941. [DOI: https://dx.doi.org/10.1053/j.gastro.2019.05.063] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31158372]
36. Nukii, Y.; Miyamoto, A.; Mochizuki, S.; Moriguchi, S.; Takahashi, Y.; Ogawa, K.; Murase, K.; Hanada, S.; Uruga, H.; Takaya, H. et al. Pneumatosis intestinalis induced by osimertinib in a patient with lung adenocarcinoma harbouring epidermal growth factor receptor gene mutation with simultaneously detected exon 19 deletion and T790 M point mutation: A case report. BMC Cancer; 2019; 19, 186. [DOI: https://dx.doi.org/10.1186/s12885-019-5399-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30819142]
37. Chaudhry, N.S.; Bi, W.L.; Gupta, S.; Keraliya, A.; Shimizu, N.; Chiocca, E.A. Pneumatosis Intestinalis After Molecular-Targeted Therapy. World Neurosurg.; 2019; 125, pp. 312-315. [DOI: https://dx.doi.org/10.1016/j.wneu.2019.01.225]
38. González-Olivares, C.; Palomera-Rico, A.; Blanca, N.R.-P.; Sánchez-Aldehuelo, R.; Figueroa-Tubío, A.; de la Filia, I.G.; López-Sanromán, A. Neumatosis intestinal en la enfermedad de Crohn. Gastroenterol. Hepatol.; 2019; 42, pp. 181-183. [DOI: https://dx.doi.org/10.1016/j.gastrohep.2018.05.007]
39. Kelly, G.S.; Grandy, B.; Rice, J. Diffuse Pneumatosis Coli. J. Emerg. Med.; 2018; 54, pp. e137-e139. [DOI: https://dx.doi.org/10.1016/j.jemermed.2018.02.008]
40. Shindo, M.; Ito, K.; Tabei, K.; Morishita, Y. Severe pneumatosis intestinalis with portal venous gas. Saudi J. Gastroenterol.; 2018; 24, 69. [DOI: https://dx.doi.org/10.4103/sjg.SJG_545_17]
41. Okuda, Y.; Mizuno, S.; Koide, T.; Suzaki, M.; Isaji, S. Surgical treatment of pneumatosis cystoides intestinalis with pneumoperitoneum secondary. Turk. J. Gastroenterol.; 2018; 29, pp. 129-131. [DOI: https://dx.doi.org/10.5152/tjg.2018.17519]
42. Liu, T.; Zhang, S.; Mao, H. Gastrointestinal malignant neoplasms disguised as pneumatosis cystoids intestinalis: A case report and literature review. Medicine; 2017; 96, e9410. [DOI: https://dx.doi.org/10.1097/MD.0000000000009410]
43. Zimmer, V.; Schnabel, P.A.; Lammert, F. A Flat Tire in the Colon. Gastroenterology; 2018; 154, pp. e8-e9. [DOI: https://dx.doi.org/10.1053/j.gastro.2017.05.023]
44. Telegrafo, M.; Stabile Ianora, A.A.; Angelelli, G.; Moschetta, M. Reversible pneumatosis cystoides intestinalis after liver transplantation. G. Chir.; 2017; 38, pp. 239-242. [DOI: https://dx.doi.org/10.11138/gchir/2017.38.5.239]
45. Liang, J.T.; Chen, T.C. Pneumatosis cystoides intestinalis. Asian J. Surg.; 2018; 41, 98. [DOI: https://dx.doi.org/10.1016/j.asjsur.2017.11.001]
46. Ohkuma, K.; Saraya, T.; Shimoda, M.; Takizawa, H. A case of pneumatosis cystoides intestinalis. J. Gen. Fam. Med.; 2017; 18, pp. 481-482. [DOI: https://dx.doi.org/10.1002/jgf2.127] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29264102]
47. Mikami, T.; Kakimoto, K.; Hirata, Y.; Kawakami, K.; Takeuchi, T.; Higuchi, K. Pneumatosis Cystoides Intestinalis in a Patient with Ulcerative Colitis. J. Gastrointest. Liver Dis.; 2017; 26, 337. [DOI: https://dx.doi.org/10.15403/jgld.2014.1121.264.hig] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29253045]
48. Ribaldone, D.G.; Bruno, M.; Gaia, S.; Maria Saracco, G.; De Angelis, C. Endoscopic ultrasound to diagnose pneumatosis cystoides intestinalis (with video). Endosc. Ultrasound; 2017; 6, pp. 416-417. [DOI: https://dx.doi.org/10.4103/eus.eus_88_17] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29251277]
49. Sugihara, Y.; Okada, H. Pneumatosis Cystoides Intestinalis. N. Engl. J. Med.; 2017; 377, 2266. [DOI: https://dx.doi.org/10.1056/NEJMicm1701357] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29211667]
50. Robinson, A.J.; Quigley, J.-P.; Banks, A.; Farmer, M. Ogilvie’s syndrome treated with an emergency laparotomy, right hemicolectomy and end ileostomy. BMJ Case Rep.; 2017; 2017, bcr-2017-220916. [DOI: https://dx.doi.org/10.1136/bcr-2017-220916] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29018144]
51. Rachapalli, V.; Chaluvashetty, S.B. Pneumatosis Cystoides Intestinalis. J. Clin. Diagn. Res.; 2017; 11, pp. TJ01-TJ02. [DOI: https://dx.doi.org/10.7860/JCDR/2017/26197.10087]
52. Beetz, O.; Kleine, M.; Vondran, F.W.R.; Cammann, S.; Klempnauer, J.; Kettler, B. A Case of Recurrent Pneumoperitoneum and Pneumatosis Intestinalis After Bilateral Lung Transplant. Transplantation; 2019; 17, pp. 124-127. [DOI: https://dx.doi.org/10.6002/ect.2016.0249]
53. Kanwal, D.; Attia, K.M.E.; Fam, M.N.A.; Khalil, S.M.F.; Alblooshi, A.M. Stercoral perforation of the rectum with faecal peritonitis and pneumatosis coli: A case Report. J. Radiol. Case Rep.; 2017; 11, pp. 1-6. [DOI: https://dx.doi.org/10.3941/jrcr.v11i3.3060]
54. Suzuki, E.; Kanno, T.; Hazama, M.; Kobayashi, H.; Watanabe, H.; Ohira, H. Four Cases of Pneumatosis Cystoides Intestinalis Complicated by Connective Tissue Diseases. Intern. Med.; 2017; 56, pp. 1101-1106. [DOI: https://dx.doi.org/10.2169/internalmedicine.56.7877]
55. Tsuji, T.; Sonobe, S.; Koba, T.; Maekura, T.; Takeuchi, N.; Tachibana, K. Systemic Air Embolism Following Diagnostic Bronchoscopy. Intern. Med.; 2017; 56, pp. 819-821. [DOI: https://dx.doi.org/10.2169/internalmedicine.56.7836]
56. Nishimura, J.M.; Farzaneh, T.; Pigazzi, A. Pneumatosis coli causing pneumoperitoneum. J. Surg. Case Rep.; 2017; 2017, rjw233. [DOI: https://dx.doi.org/10.1093/jscr/rjw233] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28096327]
57. Faria, L.D.; Anjos, C.H.; Fernandes, G.D.; Carvalho, I.F. Pneumatosis intestinalis after etoposide-based chemotherapy in a patient with metastatic small cell lung cancer: Successful conservative management of a rare condition. Einstein; 2016; 14, pp. 420-422. [DOI: https://dx.doi.org/10.1590/S1679-45082016RC3597]
58. Fujiya, T.; Iwabuchi, M.; Sugimura, M.; Ukai, K.; Tadokoro, K. A Case of Intussusception Associated with Pneumatosis Cystoides Intestinalis. Case Rep. Gastroenterol.; 2016; 10, pp. 494-498. [DOI: https://dx.doi.org/10.1159/000448876] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27721738]
59. Furihata, T.; Furihata, M.; Ishikawa, K.; Kosaka, M.; Satoh, N.; Kubota, K. Does massive intraabdominal free gas require surgical intervention?. World J. Gastroenterol.; 2016; 22, pp. 7383-7388. [DOI: https://dx.doi.org/10.3748/wjg.v22.i32.7383] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27621584]
60. Maeda, A.; Nakata, M.; Shimizu, K.; Yukawa, T.; Saisho, S.; Okita, R. Pneumatosis intestinalis after gefitinib therapy for pulmonary adenocarcinoma: A case report. World J. Surg. Oncol.; 2016; 14, pp. 1-4. [DOI: https://dx.doi.org/10.1186/s12957-016-0926-1]
61. Fraga, M.; Silva, M.J.N.D.; Lucas, M. Idiopathic Pneumatosis Intestinalis, Radiological and Endoscopic Images. GE Port. J. Gastroenterol.; 2016; 23, pp. 270-272. [DOI: https://dx.doi.org/10.1016/j.jpge.2016.01.005] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28868475]
62. Gassend, J.L.; Dimitrief, M.; Roulet, D.; Cherbanyk, F. Large bowel pneumatosis intestinalis: To operate or not to operate?. BMJ Case Rep.; 2016; 2016, bcr2016214612. [DOI: https://dx.doi.org/10.1136/bcr-2016-214612]
63. Castren, E.E.; Hakeem, A.R.; Mahmood, N.S.; Aryal, K. Case of pneumatosis intestinalis and hepatic portal venous gas following a laparoscopic right hemicolectomy. BMJ Case Rep.; 2016; 2016, bcr2016214431. [DOI: https://dx.doi.org/10.1136/bcr-2016-214431] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27001599]
64. Waterland, P.; Jones, A.D.; Peleki, A.; Zilvetti, M. Fulminant pneumatosis coli: A rare presentation of hollow viscus injury after blunt abdominal trauma. J. Emerg. Trauma. Shock.; 2016; 9, pp. 40-42. [DOI: https://dx.doi.org/10.4103/0974-2700.167666] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26957828]
65. Keklik, F.; Cayci, Z.; Arndt, P.; Ustun, C. Spontaneous complete resolution of pneumomediastinum pneumatosis intestinalis caused by acute GVHD. Am. J. Hematol.; 2016; 91, pp. 749-750. [DOI: https://dx.doi.org/10.1002/ajh.24337]
66. Ksiadzyna, D.; Peña, A.S. Segmental pneumatosis cystoides coli: Computed tomography-facilitated diagnosis. Rev. Esp. Enferm. Dig.; 2016; 108, pp. 510-513. [DOI: https://dx.doi.org/10.17235/reed.2015.3790/2015]
67. Vargas, A.; Pagés, M.; Buxó, E. Pneumatosis intestinalis due to 5-fluorouracil chemotherapy. Neumatosis intestinal secundaria a quimioterapia con 5-fluorouracilo. Gastroenterol. Hepatol.; 2016; 39, pp. 672-673. [DOI: https://dx.doi.org/10.1016/j.gastrohep.2015.09.010]
68. Ling, F.Y.; Zafar, A.M.; Angel, L.F.; Mumbower, A.L. Benign pneumatosis intestinalis after bilateral lung transplantation. BMJ Case Rep.; 2015; 2015, bcr2015210701. [DOI: https://dx.doi.org/10.1136/bcr-2015-210701]
69. Rottenstreich, A.; Agmon, Y.; Elazary, R. A Rare Case of Benign Pneumatosis Intestinalis with Portal Venous Gas and Pneumoperitoneum Induced by Acarbose. Intern. Med.; 2015; 54, pp. 1733-1736. [DOI: https://dx.doi.org/10.2169/internalmedicine.54.4255]
70. Balasuriya, H.D.; Abeysinghe, J.; Cocco, N. Portal venous gas and pneumatosis coli in severe cytomegalovirus colitis. ANZ J. Surg.; 2018; 88, pp. 113-114. [DOI: https://dx.doi.org/10.1111/ans.13224]
71. Pulat, H.; Celik, G.; Sabuncuoglu, M.Z.; Benzin, M.F.; Karakose, O.; Cetin, R. Pneumatosis cystoides intestinalis: A rare cause of intraabdominal free air. Turk. J. Surg.; 2017; 33, pp. 315-317. [DOI: https://dx.doi.org/10.5152/UCD.2015.3108]
72. Helo, N.; Rhee, K.; Dugum, M. An Intriguing Case of Bright Red Blood per Rectum. Pneumatosis Cystoids Intestinalis. Gastroenterology; 2015; 149, pp. e1-e2. [DOI: https://dx.doi.org/10.1053/j.gastro.2014.12.037]
73. Araújo, T.F.; Pedroto, I. Endoscopic ultrasound of pneumatosis cystoides intestinalis. Endoscopy; 2015; 47, (Suppl. 1), E274. [DOI: https://dx.doi.org/10.1055/s-0034-1391873]
74. Ooi, S.M. Fulminant Shigellosis in a HIV Patient. Case Rep. Infect. Dis.; 2015; 2015, 128104. [DOI: https://dx.doi.org/10.1155/2015/128104]
75. Blair, H.A.; Baker, R.; Albazaz, R. Pneumatosis intestinalis an increasingly common radiological finding, benign or life-threatening? A case series. BMJ Case Rep.; 2015; 2015, bcr2014207234. [DOI: https://dx.doi.org/10.1136/bcr-2014-207234]
76. Chandola, R.; Elhenawy, A.; Lien, D.; Laing, B. Massive gas under diaphragm after lung transplantation: Pneumatosis intestinalis simulating bowel perforation. Ann. Thorac. Surg.; 2015; 99, pp. 687-689. [DOI: https://dx.doi.org/10.1016/j.athoracsur.2014.03.047]
77. Grimm, J.C.; Berger, J.C.; Lipsett, P.A.; Haut, E.R.; Ferrada, P. A case of profound pneumatosis intestinalis in a patient with recent polytrauma. J. Trauma: Inj. Infect. Crit. Care; 2015; 78, pp. 209-210. [DOI: https://dx.doi.org/10.1097/TA.0000000000000500]
78. Choi, J.Y.; Cho, S.B.; Kim, H.H.; Lee, I.H.; Lee, H.Y.; Kang, H.S.; Lee, H.Y.; Lee, S.Y. Pneumatosis Intestinalis Complicated by Pneumoperitoneum in a Patient with Asthma. Tuberc. Respir. Dis.; 2014; 77, pp. 219-222. [DOI: https://dx.doi.org/10.4046/trd.2014.77.5.219] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25473410]
79. Aziret, M.; Erdem, H.; Ülgen, Y.; Kahramanca, Ş.; Çetinkünar, S.; Bozkurt, H.; Bali, I.; İrkörücü, O. The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature. Int. J. Surg. Case Rep.; 2014; 5, pp. 909-913. [DOI: https://dx.doi.org/10.1016/j.ijscr.2014.09.031] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25460434]
80. Rodrigues-Pinto, E.; Ramalho, R.; Baldaia, H.; Macedo, G. Pneumatosis cystoides intestinalis secondary to increased intraluminal air pressure of previous colonoscopies. Endoscopy; 2014; 46, (Suppl. S1), pp. E572-E573. [DOI: https://dx.doi.org/10.1055/s-0034-1377985] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25409079]
81. Jacob, T.; Paracha, M.; Penna, M.; Arul, D.; Wilson, J. Pneumatosis Coli Mimicking Colorectal Cancer. Case Rep. Surg.; 2014; 2014, 428989. [DOI: https://dx.doi.org/10.1155/2014/428989]
82. Neesse, A.; Nimphius, W.; Schoppet, M.; Gress, T.M. Abdominal pain following percutaneous mitral valve repair (MitraClip). Pneumatosis intestinalis (PI) of the ascending colon. Gut; 2015; 64, pp. 458-494. [DOI: https://dx.doi.org/10.1136/gutjnl-2014-308495]
83. Santos-Antunes, J.; Ramalho, R.; Lopes, S.; Guimarães, S.; Carneiro, F.; Macedo, G. Asymptomatic pneumatosis cystoides intestinalis diagnosed in the follow-up of a dysplastic polyp. Endoscopy; 2013; 46, pp. E425-E426. [DOI: https://dx.doi.org/10.1055/s-0034-1377435] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25314176]
84. Martis, N.; Baque-Juston, M.; Buscot, M.; Marquette, C.-H.; Leroy, S. An unexpected discovery complicating sicca syndrome. Eur. Respir. Rev.; 2014; 23, pp. 397-398. [DOI: https://dx.doi.org/10.1183/09059180.00000114] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25176978]
85. Krüger, A.K.; Schmidt, C. LocG. Portal venous gas—Always an ominous sign?. Ultraschall Med.; 2014; 35, pp. 495-496. [DOI: https://dx.doi.org/10.1055/s-0034-1366731] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25075908]
86. Tseng, P.Y.; Tarng, D.C.; Yang, W.C.; Yang, C.Y. Benign pneumatosis intestinalis. Intern. Med.; 2014; 53, pp. 1589-1590. [DOI: https://dx.doi.org/10.2169/internalmedicine.53.2657]
87. Rajpal, S.; Akkus, N.I. Pneumatosis intestinalis, a dreaded complication of intra-aortic balloon pump use. J. Invasive Cardiol.; 2014; 26, pp. E104-E105. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24993995]
88. Bamakhrama, K.; Abdulhady, L.; Vilmann, P. Endoscopic ultrasound diagnosis of pneumatosis cystoides coli initially misdiagnosed as colonic polyps. Endoscopy; 2014; 46, (Suppl. S1), pp. E195-E196. [DOI: https://dx.doi.org/10.1055/s-0034-1365152] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24756292]
89. Chao, C.T. Prolonged ileus with pneumatosis cystoides intestinalis. Acta Clin. Belg.; 2014; 69, pp. 224-225. [DOI: https://dx.doi.org/10.1179/2295333714Y.0000000021]
90. Jurado-Román, M.; Calero-García, P.; Flores-Garnica, L.M.; Sagredo, M.d.P.; Scortechini, M.; Calderón-Gómez, M.; Valiente-Carrillo, J. Pneumatosis cystoides intestinalis. Uncommon cause of pneumoperitoneum. Rev. Esp. Enferm. Dig.; 2014; 106, pp. 71-72. [DOI: https://dx.doi.org/10.4321/S1130-01082014000100018]
91. Pinto Pais, T.; Pinho, R.; Carvalho, J. Hepatic portal venous gas and intestinal pneumatosis as initial presentation of Crohn’s disease: First case report. J. Crohns Colitis; 2014; 8, pp. 1329-1330. [DOI: https://dx.doi.org/10.1016/j.crohns.2014.02.023]
92. Lemos, A.A.; Cioffi, U.; Ossola, M.W.; Conte, D. Appendicitis-related pneumatosis intestinalis and portal venous gas in a pregnant woman. Dig. Liver Dis.; 2014; 46, pp. 476-477. [DOI: https://dx.doi.org/10.1016/j.dld.2013.12.020]
93. Qin, Q.; Ma, T.; Wang, L. Acute dyspnea during diagnostic sigmoidoscopy. Gastroenterology; 2014; 146, pp. e1-e3. [DOI: https://dx.doi.org/10.1053/j.gastro.2013.09.054]
94. Lim, C.X.; Tan, W.J.; Goh, B.K. Benign pneumatosis intestinalis. Clin. Gastroenterol. Hepatol.; 2014; 12, pp. xxv-xxvi. [DOI: https://dx.doi.org/10.1016/j.cgh.2013.12.031] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24429056]
95. Nakajima, N.; Ueda, M.; Yamamoto, K.; Katayama, Y. Pneumatosis intestinalis in a patient with myasthenia gravis. Intern. Med.; 2013; 52, pp. 2835-2836. [DOI: https://dx.doi.org/10.2169/internalmedicine.52.1400]
96. Bareggi, E.; Tonolini, M.; Ardizzone, S. Pneumatosis intestinalis and perforation in Crohn’s disease: Worrisome or not?. J. Crohns Colitis; 2014; 8, pp. 338-339. [DOI: https://dx.doi.org/10.1016/j.crohns.2013.11.010] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24295647]
97. Fong, K.Y.; Siao, F.Y.; Yen, H.H. Cecal pneumatosis intestinalis in obstructing sigmoid cancer: Emergency metallic stenting. Am. J. Emerg. Med.; 2014; 32, pp. 395.e1-395.e3. [DOI: https://dx.doi.org/10.1016/j.ajem.2013.10.040]
98. Zarbalian, Y.; von Rosenvinge, E.C.; Twadell, W.; Mikdashi, J. Recurrent pneumatosis intestinalis in a patient with dermatomyositis. BMJ Case Rep.; 2013; 2013, bcr2013200308. [DOI: https://dx.doi.org/10.1136/bcr-2013-200308]
99. Lommen, M.J.; Zineldine, O.; I Mehta, T.; E Radtke, L.; Serrano, O. Pneumatosis Cystoides Intestinalis Identified on Screening Colonoscopy With Associated Pneumoperitoneum. Cureus; 2020; 12, e9512. [DOI: https://dx.doi.org/10.7759/cureus.9512] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32884868]
100. Ezuka, A.; Kawana, K.; Nagase, H.; Takahashi, H.; Nakajima, A. Improvement of pneumatosis cystoides intestinalis after steroid tapering in a patient with bronchial asthma: A case report. J. Med. Case Rep.; 2013; 7, 163. [DOI: https://dx.doi.org/10.1186/1752-1947-7-163]
101. Siddiqui, M.; Jain, A.; Rizvi, S.; Ahmad, K.; Ullah, E.; Ahmad, I. Necrotizing colitis complicating necrotized pancreatitis: Look out for intestinal pneumatosis. J. Belg. Soc. Radiol.; 2013; 96, 19. [DOI: https://dx.doi.org/10.5334/jbr-btr.169]
102. Tanabe, S.; Shirakawa, Y.; Takehara, Y.; Maeda, N.; Katsube, R.; Ohara, T.; Sakurama, K.; Noma, K.; Fujiwara, T. Successfully treated pneumatosis cystoides intestinalis with pneumoperitoneum onset in a patient administered α-glucosidase inhibitor. Acta Medica Okayama; 2013; 67, pp. 123-128. [DOI: https://dx.doi.org/10.18926/amo/49672]
103. Adar, T.; Paz, K. Images in clinical medicine. Pneumatosis intestinalis. N. Engl. J. Med.; 2013; 368, e19. [DOI: https://dx.doi.org/10.1056/NEJMicm1205591]
104. Rahim, H. Gastrointestinal sarcoidosis associated with pneumatosis cystoides intestinalis. World J. Gastroenterol.; 2013; 19, pp. 1135-1139. [DOI: https://dx.doi.org/10.3748/wjg.v19.i7.1135]
105. Liang, H.-H.; Wang, W.; Hung, C.-S.; Wei, P.-L.; Yen, K.-L.; Kuo, L.-J.; Tu, C.-C. Branch-type Gas in the Liver. J. Emerg. Med.; 2013; 44, pp. e363-e364. [DOI: https://dx.doi.org/10.1016/j.jemermed.2012.11.029] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23375219]
106. de Leon, M.P.; Bertarelli, C.; Casadei, G.P.; Grilli, A.; Bacchini, P.; Pedroni, M.; Jovine, E. A case of pneumatosis cystoides intestinalis mimicking familial adenomatous polyposis. Fam. Cancer; 2012; 12, pp. 573-576. [DOI: https://dx.doi.org/10.1007/s10689-012-9587-6] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23196630]
107. Mourra, N.; Fontugne, J. Extensive pneumatosis coli misdiagnosed and mismanaged as polyposis. Scand. J. Gastroenterol.; 2013; 48, pp. 119-120. [DOI: https://dx.doi.org/10.3109/00365521.2012.722676]
108. Masuda, N.; Nagata, K.; Mitsushima, T.; Fujiwara, M. Computed tomographic colonography in diagnosis of asymptomatic pneumatosis cystoides intestinalis. Dig. Liver Dis.; 2013; 45, 79. [DOI: https://dx.doi.org/10.1016/j.dld.2012.07.016] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22938700]
109. Kashima, T.; Ohno, Y.; Tachibana, M. Pneumatosis intestinalis and hepatic portal venous gas in a patient receiving sorafenib. Int. J. Urol.; 2012; 19, pp. 1041-1042. [DOI: https://dx.doi.org/10.1111/j.1442-2042.2012.03099.x] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22788573]
110. Aitken, E.; Lyon, A.; Felstenstein, I. An unusual case of acalculous cholecystitis heralding presentation of acute mesenteric ischaemia with typical radiological findings. Int. J. Surg. Case Rep.; 2012; 3, pp. 346-348. [DOI: https://dx.doi.org/10.1016/j.ijscr.2012.04.006] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22580081]
111. Makni, A.; Daghfous, A.; Rebai, W.; Zghab, S.; Jouini, M.; Kacem, M.; Safta, B. Idiopathic aeroportia and gastric pneumatosis. Tunis. Med.; 2012; 90, pp. 336-337.
112. Balbir-Gurman, A.; Brook, O.R.; Chermesh, I.; Braun-Moscovici, Y. Pneumatosis cystoides intestinalis in scleroderma-related conditions. Intern. Med. J.; 2012; 42, pp. 323-329. [DOI: https://dx.doi.org/10.1111/j.1445-5994.2011.02557.x]
113. Schieber, J.R.; Sherman, S.C. Pneumatosis intestinalis and ulcerative colitis. J. Emerg. Med.; 2013; 44, pp. 472-473. [DOI: https://dx.doi.org/10.1016/j.jemermed.2012.01.023]
114. Lee, J.Y.; Han, H.-S.; Lim, S.-N.; Shim, Y.K.; Choi, Y.H.; Lee, O.-J.; Lee, K.H.; Kim, S.T. Pneumatosis intestinalis and portal venous gas secondary to Gefitinib therapy for lung adenocarcinoma. BMC Cancer; 2012; 12, 87. [DOI: https://dx.doi.org/10.1186/1471-2407-12-87] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22405425]
115. Vijayakanthan, N.; Dhamanaskar, K.; Stewart, L.; Connolly, J.; Leber, B.; Walker, I.; Trus, M. A Review of Pneumatosis Intestinalis in the Setting of Systemic Cancer Treatments, Including Tyrosine Kinase Inhibitors. Can. Assoc. Radiol. J.; 2012; 63, pp. 312-317. [DOI: https://dx.doi.org/10.1016/j.carj.2011.06.004] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22402108]
116. Chang, C.J.; Lin, M.S.; Tsai, K.C.; Sun, J.T. Pneumatosis intestinalis and portomesenteric vein gas in ischemic bowel disease. J. Emerg. Med.; 2012; 43, pp. e475-e476. [DOI: https://dx.doi.org/10.1016/j.jemermed.2011.06.142] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22341760]
117. Martin-Smith, J.D.; Larkin, J.O.; Hogan, J.G.; Ravi, N.; Reynolds, J.V. Necrotizing pancreatitis presenting with pneumatosis coli and hepatic portal venous gas. ANZ J. Surg.; 2011; 81, pp. 467-468. [DOI: https://dx.doi.org/10.1111/j.1445-2197.2011.05760.x]
118. Hong, K.D.; Lee, S.I.; Moon, H.Y. Pneumatosis intestinalis and laparoscopic exploration: Beware of gas explosion. J. Laparoendosc. Adv. Surg. Tech. A; 2012; 22, pp. 273-275. [DOI: https://dx.doi.org/10.1089/lap.2011.0465] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22288881]
119. Hoot, N.R.; Pfennig, C.L.; Johnston, M.N.; Jones, I. An incidental finding? Pneumatosis intestinalis after minor trauma. J. Emerg. Med.; 2013; 44, pp. e145-e147. [DOI: https://dx.doi.org/10.1016/j.jemermed.2011.09.009]
120. Shimada, R.; Hayama, T.; Yamazaki, N.; Akahane, T.; Horiuchi, A.; Shibuya, H.; Yamada, H.; Ishihara, S.; Nozawa, K.; Matsuda, K. et al. Intestinal Pneumatosis in Which CT Colonography Was of Significant Diagnostic Value: Case Report. Int. Surg.; 2011; 96, pp. 217-219. [DOI: https://dx.doi.org/10.9738/1379.1]
121. Iwasaku, M.; Yoshioka, H.; Korogi, Y.; Kunimasa, K.; Nishiyama, A.; Nagai, H.; Ishida, T. Pneumatosis Cystoides Intestinalis After Gefitinib Therapy for Pulmonary Adenocarcinoma. J. Thorac. Oncol.; 2012; 7, 257. [DOI: https://dx.doi.org/10.1097/JTO.0b013e3182381564] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22173663]
122. Nancy Fu, Y.T.; Kim, E.; Bressler, B. Pneumatosis intestinalis after colonoscopy in a Crohn’s disease patient with mucosal healing. Inflamm. Bowel Dis.; 2013; 19, pp. E7-E8. [DOI: https://dx.doi.org/10.1002/ibd.22840] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22147522]
123. Sagara, A.; Kitagawa, K.; Furuichi, K.; Kitajima, S.; Toyama, T.; Okumura, T.; Hara, A.; Sakai, Y.; Kaneko, S.; Wada, T. Three cases of pneumatosis intestinalis presenting in autoimmune diseases. Mod. Rheumatol.; 2011; 22, pp. 610-615. [DOI: https://dx.doi.org/10.3109/s10165-011-0551-3] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22068684]
124. Jarkowski, A., 3rd; Hare, R.; Francescutti, V.; Wilkinson, N.; Khushalani, N. Case report of pneumatosis intestinalis secondary to sunitinib treatment for refractory gastrointestinal stromal tumor. Anticancer. Res.; 2011; 31, pp. 3429-3432.
125. Wu, S.S.; Yen, H.H. Images in clinical medicine. Pneumatosis cystoides intestinalis. N. Engl. J. Med.; 2011; 365, e16. [DOI: https://dx.doi.org/10.1056/NEJMicm1013439] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21864163]
126. Yoon, S.; Hong, Y.S.; Park, S.H.; Lee, J.L.; Kim, T.W. Pneumatosis Intestinalis After Cetuximab-containing Chemotherapy for Colorectal Cancer. Ultrasound Med. Biol.; 2011; 41, pp. 1225-1228. [DOI: https://dx.doi.org/10.1093/jjco/hyr114] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21835823]
127. Lioger, B.; Diot, E. Pneumatosis cystoides intestinalis in dermatomyositis. QJM; 2012; 105, pp. 801-802. [DOI: https://dx.doi.org/10.1093/qjmed/hcr127]
128. Arenal, J.J.; Said, A.; Tinoco, C.; Mato, M.J.; Otero, M.; Guerro, J. Colonic pneumatosis intestinalis in a patient with neutropenia secondary to anorexia nervosa. Rev. Esp. Enferm. Dig.; 2011; 103, pp. 391-392. [DOI: https://dx.doi.org/10.4321/s1130-01082011000700017]
129. Amrein, K.; Högenauer, C.; Spreizer, C.; Spuller, E.; Langner, C. Pneumatosis coli—An underrecognized lesion mimicking neoplastic disease. Wien. Klin. Wochenschr.; 2011; 123, pp. 515-518. [DOI: https://dx.doi.org/10.1007/s00508-011-0007-y]
130. García-Castellanos, R.; López, R.; de Vega, V.M.; Ojanguren, I.; Piñol, M.; Boix, J.; Domènech, E.; Cabré, E. Idiopathic myointimal hyperplasia of mesenteric veins and pneumatosis intestinalis: A previously unreported association. J. Crohn’s Colitis; 2011; 5, pp. 239-244. [DOI: https://dx.doi.org/10.1016/j.crohns.2010.12.003]
131. Strote, S.R.; Caroon, L.V.; Reardon, R.F. Identification of portal venous air with bedside ultrasound in the emergency department. J. Emerg. Med.; 2012; 43, pp. 698-699. [DOI: https://dx.doi.org/10.1016/j.jemermed.2010.11.042]
132. Gil Kim, Y.; Kim, K.-J.; Noh, S.H.; Yang, D.H.; Jung, K.W.; Ye, B.D.; Byeon, J.-S.; Myung, S.-J.; Yang, S.-K. Clear water filling and puncture: Sufficient for endoscopic diagnosis of pneumatosis cystoides intestinalis? (with video). Gastrointest. Endosc.; 2011; 74, pp. 1170-1171. [DOI: https://dx.doi.org/10.1016/j.gie.2010.11.027]
133. Shimojima, Y.; Ishii, W.; Matsuda, M.; Tojo, K.; Watanabe, R.; Ikeda, S. Pneumatosis cystoides intestinalis in neuropsychiatric systemic lupus erythematosus with diabetes mellitus: Case report and literature review. Mod. Rheumatol.; 2011; 21, pp. 415-419. [DOI: https://dx.doi.org/10.3109/s10165-010-0407-2]
134. Wright, N.J.; Wiggins, T.; Stubbs, B.M.; Engledow, A. Benign pneumatosis intestinalis with pneumoperitoneum and typhlitis: Side-effects of drug or disease induced immunosuppression. BMJ Case Rep.; 2011; 2011, bcr0720114518. [DOI: https://dx.doi.org/10.1136/bcr.07.2011.4518]
135. Marinello, D.K.; Rafael, D.; Paiva Edos, S.; Dominoni, R.L. Systemic lupus erythematosus complicated by intestinal vasculitis and pneumatosis intestinalis. Rev. Bras. Reumatol.; 2010; 50, pp. 596-602. [DOI: https://dx.doi.org/10.1590/S0482-50042010000500011]
136. Pasquier, M.; Waeber, G. Non-surgical pneumoperitoneum. Emerg. Med. J.; 2011; 28, 170. [DOI: https://dx.doi.org/10.1136/emj.2010.093500]
137. Bamba, S.; Tsujikawa, T.; Saotome, T.; Okuno, T.; Saito, Y.; Sasaki, M.; Andoh, A.; Fujiyama, Y. Pneumatosis coli with ulcerative colitis as a rare complication of colonoscopy. Clin. J. Gastroenterol.; 2010; 3, pp. 233-236. [DOI: https://dx.doi.org/10.1007/s12328-010-0169-6]
138. Huang, C.-T.; Liu, C.-Y.; Wu, H.-T.; Yu, Y.-B.; Tzeng, C.-H. Pneumatosis intestinalis and pneumoperitoneum after allogeneic haematopoietic stem cell transplantation. Br. J. Haematol.; 2010; 151, 118. [DOI: https://dx.doi.org/10.1111/j.1365-2141.2010.08357.x] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20738300]
139. Liao, Y.T.; Lin, T.H.; Ko, W.J. The early presence of pneumatosis in traumatic colonic perforation: A sequential computed tomography demonstration. Am. J. Emerg. Med.; 2010; 28, pp. 645.e1-645.e4. [DOI: https://dx.doi.org/10.1016/j.ajem.2009.09.015] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20579577]
140. Chaput, U.; Ducrotté, P.; Denis, P.; Nouveau, J. Pneumatosis cystoides intestinalis: An unusual cause of distal constipation. Gastroenterol. Clin. Biol.; 2010; 34, pp. 502-504. [DOI: https://dx.doi.org/10.1016/j.gcb.2010.04.008] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20537481]
141. Ong, K.-P.J.; Ng, K.-H.; Lim, K.-H.; Low, S.-C.A.; Eu, K.-W. Pneumoperitoneum resulting from pneumatosis cystoides intestinalis: A rare complication of massive colonic dilatation. Tech. Coloproctol.; 2010; 14, pp. 287-288. [DOI: https://dx.doi.org/10.1007/s10151-009-0559-2]
142. Newman, J.A.; Candfield, S.; Howlett, D.; McKenzie, P.; Sahu, S. Graft-versus-host disease. BMJ Case Rep.; 2010; 2010, [DOI: https://dx.doi.org/10.1136/bcr.05.2010.3033]
143. Syed, M.P.; Thapa, S.; Kate, Y.; Subedi, P.; Chemmanur, A. Pneumatosis Cystoides Intestinalis in the Setting of Clindamycin Use: An Association or a Coincidence?. Balk. Med J.; 2020; 38, pp. 53-54. [DOI: https://dx.doi.org/10.4274/balkanmedj.galenos.2020.2020.3.69] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32618177]
144. Meini, S.; Zini, C.; Passaleva, M.T.; Frullini, A.; Fusco, F.; Carpi, R.; Piani, F. Pneumatosis intestinalis in COVID-19. BMJ Open Gastroenterol.; 2020; 7, e000434. [DOI: https://dx.doi.org/10.1136/bmjgast-2020-000434] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32522754]
145. Miwa, W.; Hiratsuka, T.; Sato, K.; Kato, Y. Pneumatosis cystoides intestinalis lesions changing into yellowish plaque-like elastosis lesions during healing. Clin. J. Gastroenterol.; 2020; 13, pp. 1165-1172. [DOI: https://dx.doi.org/10.1007/s12328-020-01130-7] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32410155]
146. Kielty, J.; Duggan, W.P.; O’Dwyer, M. Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2. Ann. R Coll. Surg. Engl.; 2020; 102, pp. e145-e147. [DOI: https://dx.doi.org/10.1308/rcsann.2020.0145] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32538098]
147. Lakshmanan, S.; Toubia, N. Pneumatosis Intestinalis in COVID-19. Clin. Gastroenterol. Hepatol.; 2020; 19, E99. [DOI: https://dx.doi.org/10.1016/j.cgh.2020.05.048] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32485300]
148. Hokama, A.; Haranaga, S.; Tanaka, T.; Kinjo, T.; Hirata, T.; Fujita, J. Pneumatosis intestinalis and hepatic portal venous gas by paralytic ileus from Strongyloides stercoralis infestation. Pol. Arch. Intern. Med.; 2020; 130, pp. 681-682. [DOI: https://dx.doi.org/10.20452/pamw.15352] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32388970]
149. Wang, M.; Song, J.; Gong, S.; Yu, Y.; Hu, W.; Wang, Y. Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients. Medicine; 2020; 99, e19810. [DOI: https://dx.doi.org/10.1097/MD.0000000000019810] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32332623]
150. Zhang, H.; Jun, S.L.; Brennan, T.V. Pneumatosis intestinalis: Not always a surgical indication. Case Rep. Surg.; 2012; 2012, 719713. [DOI: https://dx.doi.org/10.1155/2012/719713]
151. Ribolla, M.; Conti, L.; Baldini, E.; Palmieri, G.; Grassi, C.; Banchini, F.; Dacco’, M.D.; Capelli, P. Asymptomatic pneumoperitoneum in pneumatosis coli: A misleading operative indication. Int. J. Surg. Case Rep.; 2020; 69, pp. 92-95. [DOI: https://dx.doi.org/10.1016/j.ijscr.2020.03.042]
152. Ferrada, P.; Callcut, R.; Bauza, G.; O’bosky, K.R.; Luo-Owen, X.; Mansfield, N.J.; Inaba, K.; Pasley, J.; Bugaev, N.; Pereira, B. et al. Pneumatosis Intestinalis Predictive Evaluation Study. J. Trauma Inj. Infect. Crit. Care; 2017; 82, pp. 451-460. [DOI: https://dx.doi.org/10.1097/TA.0000000000001360]
153. Matsumoto, S.; Sekine, K.; Funaoka, H.; Funabiki, T.; Yamazaki, M.; Orita, T.; Hayashida, K.; Kitano, M. Diagnostic value of intestinal fatty acid-binding protein for pneumatosis intestinalis. Am. J. Surg.; 2016; 212, pp. 961-968. [DOI: https://dx.doi.org/10.1016/j.amjsurg.2016.04.002]
154. Hani, M.B.; Kamangar, F.; Goldberg, S.; Greenspon, J.; Shah, P.; Volpe, C.; Turner, D.J.; Horton, K.; Fishman, E.K.; Francis, I.R. et al. Pneumatosis and portal venous gas: Do CT findings reassure?. J. Surg. Res.; 2013; 185, pp. 581-586. [DOI: https://dx.doi.org/10.1016/j.jss.2013.06.006]
155. Gupta, A.K.; Vazquez, O.A.; Lopez-Viego, M. Idiopathic Pneumatosis of Small Bowel and Bladder. Cureus; 2020; 12, e8313. [DOI: https://dx.doi.org/10.7759/cureus.8313]
156. Muhammad Nawawi, K.N.; Abd Samat, A.H.; Nik Fuad, N.F.; Yi, L.L. Pneumatosis intestinalis: An important radiological clue in a case of missed perforated appendicitis. Turk. J. Emerg. Med.; 2020; 20, pp. 86-89. [DOI: https://dx.doi.org/10.4103/2452-2473.278560] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32587928]
157. Gomes, A.F.; Fernandes, S.; Costa Gomes, O.; Coutinho, J. Aeroportia and pneumatosis intestinalis: Discrepancy between radiological and intraoperative findings. BMJ Case Rep.; 2020; 13, e233132. [DOI: https://dx.doi.org/10.1136/bcr-2019-233132] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32554460]
158. Takimoto, T.; Minomo, S.; Azuma, K.; Tsuyuguchi, K.; Suzuki, K. A rare cause of pneumatosis intestinalis: Intestinal amyloidosis reactive to pulmonary Mycobacterium avium infection. Int. J. Infect. Dis.; 2020; 97, pp. 329-330. [DOI: https://dx.doi.org/10.1016/j.ijid.2020.06.021] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32535303]
159. Lim, J.; Ashmore, D.; Oommen, C. A Rare Case of Chronic Small Bowel Pseudo-Obstruction. Cureus; 2020; 12, e8003. [DOI: https://dx.doi.org/10.7759/cureus.8003]
160. Fairley, L.J.; Smith, S.L.; Fairley, S.K. A case report of iatrogenic gas gangrene post colonoscopy successfully treated with conservative management- is surgery always necessary?. BMC Gastroenterol.; 2020; 20, 163. [DOI: https://dx.doi.org/10.1186/s12876-020-01314-y] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32460761]
161. A Molina, G.; Fuentes, G.; Orejuela, M.E.; Herrera, J.M.; Jiménez, G.E.; Pinto, J.C.; Cobo, M.M. Pneumatosis cystoides intestinalis in an elderly patient, better to be safe than sorry. J. Surg. Case Rep.; 2020; 2020, rjaa053. [DOI: https://dx.doi.org/10.1093/jscr/rjaa053] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32280437]
162. Arai, M.; Kim, S.; Ishii, H.; Takiguchi, T.; Yokota, H. Portal Venous Gas in Adults: Clinical Significance, Management, and Outcomes of 25 Consecutive Patients. J. Nippon. Med Sch.; 2021; 88, pp. 88-96. [DOI: https://dx.doi.org/10.1272/jnms.JNMS.2021_88-201] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32238741]
163. Police, A.; Charre, L.; Volpin, E.; Antonopulos, C.; Braham, H.; El Arbi, N. Pneumatosis cystoides intestinalis induced by the alpha-glucosidase inhibitor complicated from sigmoid volvulus in a diabetic patient. Int. J. Color. Dis.; 2020; 35, pp. 943-946. [DOI: https://dx.doi.org/10.1007/s00384-020-03549-3] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32095873]
164. Wheatley, L.; Williams, M.; Swinson, B.; Crawley-Smith, T. Benign harbinger of portal venous gas and pneumatosis intestinalis. ANZ J. Surg.; 2020; 90, pp. 1803-1805. [DOI: https://dx.doi.org/10.1111/ans.15693]
165. Tsang, C.L.N.; Lim, C.S.H.; Chen, M.Z.; Tay, Y.K.; Phan-Thien, K. Pneumatosis intestinalis: Benign or life-threatening?. ANZ J. Surg.; 2019; 90, pp. 1790-1792. [DOI: https://dx.doi.org/10.1111/ans.15668]
166. Chen, P.A.; Sun, J.T.; Lien, W.C.; Huang, C.Y. Ultrasound Imaging of Pneumatosis Intestinalis. J. Med. Ultrasound; 2019; 27, pp. 211-212. [DOI: https://dx.doi.org/10.4103/JMU.JMU_18_19] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31867198]
167. Kim, S.H.; Hwang, H.Y.; Kim, M.J.; Park, K.J.; Kim, K.-B. Early laparoscopic exploration for acute mesenteric ischemia after cardiac surgery. Acute Crit. Care; 2020; 35, pp. 213-217. [DOI: https://dx.doi.org/10.4266/acc.2018.00423]
168. Furutani, Y.; Hiranuma, C.; Hattori, M.; Doden, K.; Hashizume, Y. A case of portal venous gas after obstructive transverse colon cancer surgery. Surg. Case Rep.; 2019; 5, pp. 1-4. [DOI: https://dx.doi.org/10.1186/s40792-019-0729-z]
169. Varelas, L.J.; Klinge, M.J.; Malik, S.M.; A Borhani, A.; Neal, M. Idiopathic pneumatosis intestinalis secondary to lactulose use in patients with cirrhosis. J. Gastroenterol. Hepatol.; 2019; 35, pp. 1065-1068. [DOI: https://dx.doi.org/10.1111/jgh.14920]
170. Arai, M.; Kim, S.; Ishii, H.; Hagiwara, J.; Takiguchi, T.; Ishiki, Y.; Yokota, H. Delayed development of portal vein thrombosis in a patient initially detected with portal venous gas and pneumatosis intestinalis: A case report. Acute Med. Surg.; 2019; 6, pp. 419-422. [DOI: https://dx.doi.org/10.1002/ams2.448]
171. Belkhir, A.; Jrad, M.; Sebei, A.; Soudani, M.; Haddad, A.; Boukriba, S.; Frikha, W.; Mizouni, H. Pneumatosis cystoides intestinalis revealed after a hand-to-hand aggression: A case report. Int. J. Surg. Case Rep.; 2019; 62, pp. 100-102. [DOI: https://dx.doi.org/10.1016/j.ijscr.2019.07.071]
172. Khan, T.; Mujtaba, M.; Flores, M.S.; Nahum, K.; Carson, M.P. A Case of Pneumatosis Intestinalis With Pneumoperitoneum as a Potential Delayed Adverse Effect of Capecitabine. World J. Oncol.; 2019; 10, pp. 151-152. [DOI: https://dx.doi.org/10.14740/wjon1186] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31312282]
173. Di Pietropaolo, M.; Trinci, M.; Giangregorio, C.; Galluzzo, M.; Miele, V. Pneumatosis cystoides intestinalis: Case report and review of literature. Clin. J. Gastroenterol.; 2019; 13, pp. 31-36. [DOI: https://dx.doi.org/10.1007/s12328-019-00999-3]
174. Rivera, C.J.P.; Ramirez, N.A.; Gonzalez-Orozco, A.; Caicedo, I.; Cabrera, P. Pneumoperitoneum, pneumatosis intestinalis and portal venous gas: Rare gastrostomy complications case report. Int. J. Surg. Case Rep.; 2019; 58, pp. 174-177. [DOI: https://dx.doi.org/10.1016/j.ijscr.2019.04.018]
175. Ibrahim, A.; Edirimanne, S. Portal venous gas and pneumatosis intestinalis: Ominous findings with an idiopathic aetiology. J. Surg. Case Rep.; 2019; 2019, rjy352. [DOI: https://dx.doi.org/10.1093/jscr/rjy352] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30788091]
176. Harris, E.; Giannotti, G. Is pneumatosis cystoides intestinalis a lymphatic pathology? A case of small bowel lymphangioma and subsequent development of pneumatosis cystoides intestinalis in a 57-year-old female. J. Surg. Case Rep.; 2019; 2019, rjy334. [DOI: https://dx.doi.org/10.1093/jscr/rjy334] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30697407]
177. Bansal, R.; Shankar, U.; Walfish, A. Emphysematous Gut. Am. J. Med. Sci.; 2019; 357, e9. [DOI: https://dx.doi.org/10.1016/j.amjms.2018.11.013] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30638598]
178. Dhadlie, S.; Mehanna, D.; McCourtney, J. Pneumatosis intestinalis a trap for the unwary: Case series and literature review. Int. J. Surg. Case Rep.; 2018; 53, pp. 214-217. [DOI: https://dx.doi.org/10.1016/j.ijscr.2018.10.079] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30428434]
179. Sanford, Z.; Brown, S.; Tran, M.N.; Zahiri, H.R.; Feather, C.; Wormuth, J.; Buckley, B. Updates on the Utility of Diagnostic Laparoscopy in the Management of Pneumatosis Intestinalis: An Improvement to the Current Treatment Algorithm. Surg. Innov.; 2018; 25, pp. 648-650. [DOI: https://dx.doi.org/10.1177/1553350618803742]
180. Guan, J.; Munaf, A.; Simmonds, A.V.; Inayat, I. When the Benign Pneumatosis Intestinalis Becomes No Longer Benign: A Rare Case of Bowel Perforation in a Patient with Systemic Sclerosis. Case Rep. Gastrointest. Med.; 2018; 2018, 5124145. [DOI: https://dx.doi.org/10.1155/2018/5124145]
181. Gray, S.; Katzen, M.; Vudatha, V. A case of recurrent pneumatosis intestinalis. J. Surg. Case Rep.; 2018; 2018, rjy077. [DOI: https://dx.doi.org/10.1093/jscr/rjy077]
182. Fujimi, A.; Sakamoto, H.; Kanisawa, Y.; Minami, S.; Nagamachi, Y.; Yamauchi, N.; Ibata, S.; Kato, J. Pneumatosis intestinalis during chemotherapy with nilotinib in a patient with chronic myeloid leukemia who tested positive for anti-topoisomerase I antibodies. Clin. J. Gastroenterol.; 2016; 9, pp. 358-364. [DOI: https://dx.doi.org/10.1007/s12328-016-0683-2]
183. Yamamoto, S.; Takahashi, Y.; Ishida, H. Pneumatosis cystoides intestinalis. Ann. Gastroenterol.; 2020; 33, 541. [DOI: https://dx.doi.org/10.20524/aog.2020.0524]
184. Dibra, R.; Picciariello, A.; Trigiante, G.; Labellarte, G.; Tota, G.; Papagni, V.; Martines, G.; Altomare, D.F. Pneumatosis Intestinalis and Hepatic Portal Venous Gas: Watch and Wait or Emergency Surgery? A Case Report and Literature Review. Am. J. Case Rep.; 2020; 21, e923831. [DOI: https://dx.doi.org/10.12659/AJCR.923831]
185. Fukunaga, N.; Yoshida, S.; Shimoji, A.; Maeda, T.; Mori, O.; Yoshizawa, K.; Okada, T.; Tamura, N. Pneumatosis intestinalis and hepatic portal venous gas caused by enteral feeding after a heart valve surgery. J. Cardiol. Cases; 2022; 26, pp. 412-414. [DOI: https://dx.doi.org/10.1016/j.jccase.2022.08.007] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36506503]
186. Furtado, T.; Domingues, P.; Piedade, A.; Parreira, L.; Natário, A. A Rare and Severe Cause of Abdominal Pain in a Hemodialysis Patient. Cureus; 2022; 14, e30800. [DOI: https://dx.doi.org/10.7759/cureus.30800] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36447734]
187. Sharp, J.; Chuang, K. Benign Pneumatosis Intestinalis: A Case Report and Review of the Literature. Fed. Pract.; 2022; 39, pp. 281-285. [DOI: https://dx.doi.org/10.12788/fp.0277] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36404938]
188. Gefen, R.; Helou, B.; Shussman, N.; Elia, A.; Appelbaum, L.; Pikarsky, A.; Demma, J.A. Pneumatosis Cystoides Coli Presenting as Acute Abdomen in a Patient with Complicated Behcet’s Disease: A Case Report. Am. J. Case Rep.; 2022; 23, e937677. [DOI: https://dx.doi.org/10.12659/AJCR.937677] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36307965]
189. Miratashi Yazdi, S.A.; Chinisaz, F.; Mohammadi, L.; Najjari, K.; Zabihi Mahmoudabadi, H. Intestinal volvulus secondary to pneumatosis intestinalis: A case report. Int. J. Surg. Case Rep.; 2021; 88, 106515. [DOI: https://dx.doi.org/10.1016/j.ijscr.2021.106515]
190. Yeo, I.H.; Kim, Y.J. Two case reports of pneumatosis intestinalis in patients with cancer: Is surgical management mandatory?. Clin. Exp. Emerg. Med.; 2021; 8, pp. 237-241. [DOI: https://dx.doi.org/10.15441/ceem.20.153] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34649412]
191. Brocchi, S.; Parmeggiani, A.; Gaudiano, C.; Balacchi, C.; Renzulli, M.; Brandi, N.; Dall’Olio, F.G.; Rihawi, K.; Ardizzoni, A.; Golfieri, R. Pneumatosis intestinalis and spontaneous perforation associated with drug toxicity in oncologic patients: A case series. Acta Gastro-Enterol. Belg.; 2021; 84, pp. 497-499. [DOI: https://dx.doi.org/10.51821/84.3.015] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34599575]
192. Yamamoto, S.; Mukai, T.; Fujita, S.; Morita, Y. Barium-induced pneumatosis intestinalis in a patient with anti-synthetase syndrome. Clin. Case Rep.; 2021; 9, e04775. [DOI: https://dx.doi.org/10.1002/ccr3.4775] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34504699]
193. Della Seta, M.; Kloeckner, R.; Pinto Dos Santos, D.; Walter-Rittel, T.C.; Hahn, F.; Henze, J.; Gropp, A.; Pratschke, J.; Hamm, B.; Geisel, D. et al. Pneumatosis intestinalis and porto-mesenteric venous gas: A multicenter study. BMC Med. Imaging; 2021; 21, 129. [DOI: https://dx.doi.org/10.1186/s12880-021-00651-y] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34429069]
194. Adachi, W.; Matsushita, T.; Yashiro, Y.; Imura, J.; Shiozawa, H.; Kishimoto, K. Clinical characteristics of pneumoperitoneum with pneumatosis intestinalis detected using computed tomography: A descriptive study. Medicine; 2020; 99, e22461. [DOI: https://dx.doi.org/10.1097/MD.0000000000022461] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33019436]
195. Epin, A.; Passot, G.; Christou, N.; Monneuse, O.; Mabrut, J.Y.; Ferrero, P.A.; Caudron, S.; Pezet, D.; Magnin, B.; Grange, R. et al. Gastric Pneumatosis with Portal Venous Gas can be Treated Non-operatively: A Retrospective Multi-institutional Study. World J. Surg.; 2022; 46, pp. 784-790. [DOI: https://dx.doi.org/10.1007/s00268-021-06433-5] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35128570]
196. Treyaud, M.O.; Duran, R.; Zins, M.; Knebel, J.F.; Meuli, R.A.; Schmidt, S. Clinical significance of pneumatosis intestinalis—Correlation of MDCT-findings with treatment and outcome. Eur. Radiol.; 2017; 27, pp. 70-79. [DOI: https://dx.doi.org/10.1007/s00330-016-4348-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27106233]
197. Koss, L.G. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis): An analysis with a report of a case and a critical review of the literature. AMA Arch. Pathol.; 1952; 53, pp. 523-549.
198. St Peter, S.D.; Abbas, M.A.; Kelly, K.A. The spectrum of pneumatosis intestinalis. Arch. Surg.; 2003; 138, pp. 68-75. [DOI: https://dx.doi.org/10.1001/archsurg.138.1.68]
199. Borns, P.F.; Johnston, T.A. Indolent pneumatosis of the bowel wall associated with immune suppressive therapy. Ann. Radiol.; 1973; 16, pp. 163-166.
200. Sato, T.; Ohbe, H.; Fujita, M.; Kushimoto, S. Clinical characteristics and prediction of the asymptomatic phenotype of pneumatosis intestinalis in critically ill patients: A retrospective observational study. Acute Med. Surg.; 2020; 7, e556. [DOI: https://dx.doi.org/10.1002/ams2.556]
201. Tahiri, M.; Levy, J.; Alzaid, S.; Anderson, D. An approach to pneumatosis intestinalis: Factors affecting your management. Int. J. Surg. Case Rep.; 2015; 6, pp. 133-137. [DOI: https://dx.doi.org/10.1016/j.ijscr.2014.12.007] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25531306]
202. Kinoshita, H.; Shinozaki, M.; Tanimura, H.; Umemoto, Y.; Sakaguchi, S.; Takifuji, K.; Kawasaki, S.; Hayashi, H.; Yamaue, H. Clinical features and management of hepatic portal venous gas: Four case reports and cumulative review of the literature. Arch. Surg.; 2001; 136, pp. 1410-1414. [DOI: https://dx.doi.org/10.1001/archsurg.136.12.1410] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11735870]
203. Jamart, J. Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Acta Hepato-Gastroenterol.; 1979; 26, pp. 419-422.
204. Perrone, G.; Sartelli, M.; Mario, G.; Chichom-Mefire, A.; Labricciosa, F.M.; Abu-Zidan, F.M.; Ansaloni, L.; Biffl, W.L.; Ceresoli, M.; Coccolini, F. et al. Management of intra-abdominal-infections: 2017 World Society of Emergency Surgery guidelines summary focused on remote areas and low-income nations. Int. J. Infect. Dis.; 2020; 99, pp. 140-148. [DOI: https://dx.doi.org/10.1016/j.ijid.2020.07.046]
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Details
; Giuffrida, Mario 2
; Donato, Valentina 2 ; Gabriele Luciano Petracca 1 ; Rossi, Giorgio 1 ; Franzini, Giacomo 1 ; Cecconi, Sara 2 ; Annicchiarico, Alfredo 3
; Bonati, Elena 1 ; Catena, Fausto 4
1 Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy
2 Department of General Surgery, Maggiore Hospital, 43126 Parma, Italy
3 Department of General Surgery, AUSL Parma, 43125 Parma, Italy
4 Department of Emergency and Trauma Surgey, Bufalini Trauma Center, 47023 Cesena, Italy;