Gastrointestinal: Pneumatosis coli
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
21
Journal Issue
4
Pages
772
Date Issued
2006
Author(s)
Abstract
A woman, aged 66 years, was investigated because of the development of constipation over the preceding 12 months. Screening blood tests were within the reference range and a fecal occult blood test was negative. Colonoscopy revealed multiple, soft, polypoid masses projecting into the lumen of the sigmoid colon (Fig. 1). There was patchy redness on the surface of some of the polyps. The scout film for a computed tomography scan revealed multiple air pockets in grape-like aggregation in the mid and left abdomen. Using a lung window setting, there were clusters of small gas-filled cysts within the wall of a redundant sigmoid colon (Fig. 2). There were no radiological features of intestinal ischemia or infarction. The patient was otherwise in good health and did not have any other coexisting medical disorders such as chronic obstructive pulmonary disease. She remains well after follow-up for 1 year. Pneumatosis coli is an uncommon disorder that is characterized by the presence of multiple, gas-filled cysts in the submucosa and subserosa of the large bowel. The most common site for cysts is the sigmoid colon and cysts vary in size from a few millimeters to several centimeters. In some patients, the disorder is an incidental finding on a plain abdominal radiograph, while others have minor symptoms such as mild diarrhea, abdominal discomfort, and blood and mucus in stools. Disorders that appear to predispose to pneumatosis include chronic obstructive pulmonary disease, intestinal obstruction, AIDS and various forms of intestinal vasculitis. However, the pathogenesis of pneumatosis in these various settings is still debated. At colonoscopy, a characteristic feature is that cysts will deflate with a hiss if punctured. Complications of pneumatosis coli occur in approximately 3% of patients and include pneumoperitoneum, volvulus, intussusception, hemorrhage and intestinal perforation. In asymptomatic patients, treatment is usually unnecessary as cysts resolve spontaneously in at least 50% of patients. In patients with significant colonic symptoms, accelerated resolution of cysts and improvement in symptoms can follow treatment with antibiotics or the use of high-flow oxygen for up to several days.
SDGs
Publisher
Blackwell Publishing
Type
journal article