Case Report
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World J Gastroenterol. Nov 28, 2011; 17(44): 4932-4936
Published online Nov 28, 2011. doi: 10.3748/wjg.v17.i44.4932
Pneumatosis cystoides intestinalis
Francesco Azzaroli, Laura Turco, Liza Ceroni, Stefania Sartoni Galloni, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Mazzella
Francesco Azzaroli, Laura Turco, Liza Ceroni, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Mazzella, Department of Clinical Medicine, Division of Gastroenterology, S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
Stefania Sartoni Galloni, Department of Emergency, General Surgery and Transplantation, S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy
Author contributions: Azzaroli F, Turco L, Ceroni L, Buonfiglioli F, Calvanese C and Mazzella G all contributed to perform the research and to write the paper; Sartoni Galloni S performed the radiological study and contributed to data discussion.
Correspondence to: Francesco Azzaroli, Professor, Department of Clinical Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Telephone: +39-51-6363888 Fax: +39-51-6364120
Received: January 13, 2011
Revised: April 19, 2011
Accepted: April 26, 2011
Published online: November 28, 2011

Pneumatosis cystoides intestinalis (PCI) is a rare condition that may be associated with a variety of diseases. The presenting clinical picture may be very heterogeneous and represent a challenge for the clinician. In the present paper we describe both a common and an uncommon clinical presentation of PCI and review the pertaining literature. Our cases confirm that, apart from asymptomatic cases, the clinical presentation of PCI may be widely different and suggest that a new onset of stipsis might be the presenting symptom. Diagnosis might be suggested by a simple X-ray of the digestive tract showing a change in the characteristics of the intestinal wall in two-thirds of these patients. However, one third of the patients do not have a suggestive X-ray and require a computed tomography (CT) scan/nuclear magnetic resonance that may reveal a thickened bowel wall containing gas to confirm the diagnosis and distinguish PCI from intraluminal air or submucosal fat. CT also allows the detection of additional findings that may suggest an underlying, potentially worrisome cause of PCI such as bowel wall thickening, altered contrast mucosal enhancement, dilated bowel, soft tissue stranding, ascites and the presence of portal air. Our results also point out that clinicians and endoscopists should be aware of the possible presentations of PCI in order to correctly manage the patients affected with this disease and avoid unnecessary surgeries. The increasing number of colonoscopies performed for colon cancer screening makes PCI more frequently casually encountered and/or provoked, therefore the possible endoscopic appearances of this disease should be well known by endoscopists.

Keywords: Pneumatosis cystoides intestinalis, Pneumoperitoneum, Treatment, Hyperbaric oxygen, Endoscopy