Cystic pneumatosis of the intestine: causes, symptoms, diagnosis, treatment

Cystic pneumatosis of the intestine is very rare. According to A. A. Rusanov, by 1960, only 250 similar observations of the small intestine pneumatosis have been described in the literature, which occurs most often. In the large intestine pneumatosis occurs less often, even less often - in the stomach. True, air cysts are detected much less often in the parietal peritoneum, mesenteric lymph nodes of retroperitoneal tissue, in the wall of the bladder, the vagina. In some cases, pneumatosis of the intestine can be combined with bronchial asthma, pulmonary emphysema.

For the first time pneumatosis was described in 1754 by Duvernoy. The disease is characterized by the appearance in the intestinal wall of numerous dense vesicles containing a gas that is close in composition to atmospheric air.

The etiology and pathogenesis of the disease have not been elucidated. According to one point of view, pneumatosis is caused by the penetration of gas from the lumen of the gut through the interstitial cracks with increased intestinal pressure (spastic contractions of the intestine, increased intestinal contents in the suprastenotic area, intestinal obstruction, etc.). According to A. A. Rusanov (1960), there are cases when, after elimination of intestinal obstruction, pneumatosis disappeared. According to other authors, the appearance of gas bubbles is due to the activity of microorganisms penetrating the intestinal wall, capable of producing gas. However, it is noted that gas bubble ruptures usually do not contribute to the appearance of the inflammatory process. There is also a suggestion that an anomaly in the development of the lymphatic vessels of the intestinal wall plays a role in the occurrence of pneumatosis.

Pathomorphology. The most characteristic is the presence of cystic cavities in the intestinal wall containing gas. The sizes of gas bubbles are different, their diameter is from 1-2 mm to 1.0-1.5 cm. As a rule, they are located under the serous or mucous membrane, less often - in the muscular shell. Their wall is formed by a connective tissue, usually without elements of the epithelial or endothelial membrane. Around the cysts, inflammatory infiltrates are often observed, containing eosinophilic, and in some cases - giant cells.

Usually, gas bubbles in the wall of the small intestine are multiple, forming conglomerates like suds that crepitate at the touch, or evenly distributed over some segment, and sometimes even the entire small intestine, in the mesentery of the intestine.

Clinic. The clinical picture in most cases proceeds asymptomatically [according to AA Rusanov (1960), intestinal pneumatosis in itself does not give typical manifestations at all] and is detected only accidentally during operations. However, according to the observations of other authors, the disease can manifest with abdominal pain of uncertain character, flatulence, stool disorder (constipation or, conversely, diarrhea).

Diagnostics. As a rule, the pneumatic cysts can not be depressed. However, with their subserosic arrangement, they can be found in the stomach and duodenum with gastroduodenoscopy. In this case, the endoscopist usually tries to determine the prevalence of the process, and if it is possible to hold the endoscope in the initial parts of the jejunum, then it is possible to detect pneumatosis and this part of the intestine. In the case of a targeted X-ray examination of the small intestine, in a number of cases it is also possible to suspect large bubbles of the pneumatosis of the small intestine from changes in the relief of its mucous membrane. Subsonus pneumatosis of the small and large intestine can be suspected only in the presence of large air bubbles or their conglomerates. Suberosic pneumatosis of the intestine can be detected with laparoscopy, submucosal pneumatosis of the colon - with a colonoscopy.

Course, complications. Since pneumatosis is often combined with other, more severe diseases, they often determine not only the clinical picture, but also the prognosis. Significant conglomerates of gas bubbles, especially located circularly around any part of the intestine, can in themselves cause narrowing of its lumen and violation of the patency of intestinal contents. Spontaneous ruptures of large gas bubbles can cause pneumoperitoneum. IT Abasov (1977) described 4 patients with cystic pneumatosis of the small intestine, in 1 case there was a large accumulation of fluid and free gas in the abdominal cavity.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]