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SYB Case #3. 67-year-old male with leukemia and abdominal distention. . Radiographic finding: Pneumatosis Gas in the bowel wall. A photograph of the mucosal surface of the necrotic bowel shows numerous air bubbles which have lifted the mucosa away from the muscularis.

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A photograph of the mucosal surface of the necrotic bowel shows numerous air bubbles which have lifted the mucosa away from the muscularis
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Primary pneumatosisintestinalis (15% of cases) is a benign idiopathic condition in which multiple thin-walled cysts 10-100mm develop in the submucosa or subserosa of the colon.

  • Secondary form (85% of cases) is associated with obstructive pulmonary disease, as well as with obstructive and necrotic gastrointestinal disease. Linear or curvilinear gas collections seen parallel to the bowel wall
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1.Necrotic GI disease:

    • Necrotizing enterocolitis
    • Mesenteric ischemia-Life threatening emergency 50-75% mortality
    • Caustic ingestions
  • 2.Nonnecrotic GI disease:
    • Obstruction/increased intraluminal pressure
    • Inflammation/Ulceration
    • Collagen vascular disease
    • Abdominal trauma.
    • Immunosuppresion
    • Infection
  • 3.Obstructive Pulmonary disease:
    • Rupture of pulmonary blebs in obstructive lung disease may cause air to dissect through the retroperitoneum, into the mesentery, and, finally, to the bowel subserosa and submucosa.
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Signs and symptoms include diarrhea, bloody stools, abdominal pain, abdominal distention, and constipation. The physical findings are usually unremarkable.

  • Prognosis depends on the overall clinical picture.
  • NEC has a mortality rate of about 30%, and as many as 50% of patients may require surgery for perforation.
  • Pneumatosis is an ominous radiographic finding in patients suspected of having bowel ischemia—signs of perforation, peritonitis, or abdominal sepsis.
mesenteric ischemia
Mesenteric Ischemia
  • Decreased intestinal blood flow results in ischemia and subsequent reperfusion damage at the cellular level that may progress to the development of mucosal injury, tissue necrosis, and metabolic acidosis.
  • Acute (arterial embolism, thrombosis, vasoconstriction-sepsis/hypovolemia/cocaine, hypercoagulable states)
  • Chronic (long-standing atherosclerotic disease of 2 or more mesenteric vessels, vasculitides, worse during meals)
  • *Relatively normal abdominal examination in the face of severe abdominal pain.