Pneumatosis intestinalis

Pneumatosis intestinalis and pneumoperitoneum have been reported in a 57-year-old cirrhotic man with colonic inertia who had been taking oral lactulose 30 ml tds (38). Because of constipation the dose of lactulose had been gradually increased to 60 ml qds together with lactulose enemas. Both conditions resolved 3 days after oral lactulose was withdrawn. 

Fig. 1.36a-c. Pneumatosis intestinalis in a 1-week-old infant. Anteroposterior (a) and lateral (b) plain radiographs show small and large bowel loops sharply outlined by collections of gas in bowel wall. Most of these collections of gas are linear, indicating a submucosal location, c Surgical image of the same patient demonstrates diffuse bowel necrosis... 

Fig. 1.37. Pneumatosis intestinalis in 12-day-old infant. Abdominal radiograph demonstrates increase in the amount of gas in the small bowel. Pneumatosis intestinalis is identified as cystic lucencies in the right upper and lower quadrant. These cystic lucencies are usually subserosal...

Fig. 1.39a,b. Portal vein air. Plain radiographs, a Air is observed within the portal vein branches complicating pneumatosis intestinalis in a 3-week-old premature infant, b Another premature infant with pneumatosis intestinalis and air within the portal... 

Fig. 1.41a,b. Necrotizing enterocolitis. a,b. Longitudinal US scans at the transverse colon show air bubbles (arrows) within the colonic wall corresponding to pneumatosis intestinalis... 

Nakajima T, Murayama N, Owa 0, et al. 1990a. [Trichloroethylene concentration in work environment in relation to the development of pneumatosis cystoides intestinalis.] Sangyo Igaku 32 454-460. (Japanese)... 

Sato A, Yamaguchi K, Nakajima T. 1986. Occupational trichloroethylene exposure as an etiological factor of Pneumatosis cystoides intestinalis. Toxicol Lett 81(Suppl) 16-17. 

Azami Y. Paralytic ileus accompanied by pneumatosis cystoides intestinalis after acarbose treatment in an elderly diabetic patient with a history of heavy intake of maltitol. Intern Med 2000 39(10) 826-9. 

Maeda A, Yokoi S, Kunou T, Murata T. [A case of pneumatosis cystoides intestinalis assumed to be induced by acarbose administration for diabetes mellitus and pemphigus vulgaris.JNippon Shokakibyo Gakkai Zasshi 2002 99(ll) 1345-9. 

Pneumatosis cystoides intestinalis is not actually a submucosal tumor, but the endoscopic features resemble those of a submucosal tumor. Endoscopic ultrasound shows an echogenic spot with a comet-tail artifact in the submucosal layer, which represents the air bubble (Fig. 19.12). 

Fig. 19.12. Endosonographic feature of pneumatosis cystoides intestinalis. A strong echo (asterisk) with a comet-tail echo is demonstrated in the submucosal layer of the colon wall...

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