Residents' corner. Answer to case of the month #38. Pneumatosis intestinalis after bone marrow transplantation.
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A case is presented that illustrates the value of CT in detecting pneumatosis intestinalis prior to plain film findings.
The study included 30 patients with gastroenteritis and pneumatosis intestinalis, seen at the pediatric hospital of the IMSS, who followed a satisfactory course. Complications and associated diseases were found in these patients to be less severe than in other patients who died. Lethality in this type of patients (33%) is analyzed together with the clinical records in 33 cases of death from gastroenteritis and pneumatosis intestinalis during the period from January 1974 to April 1975. It was found that the period of hospital stay was shorter than in the group that recovered; that complications leading to death were severe and of acute evolution among which, bronchopneumonia, septic shock, intestinal infarct and others, predominated. Decrease in lethality may be considered to lie in an earlier diagnosis together with prevention and treatment of pneumatosis intestinalis and its complications.
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This report describes a 2 1/2-year-old boy who sustained blunt abdominal trauma and had pneumatosis intestinalis in the right colon. The child was successfully managed by observation. The pneumatosis resolved spontaneously.
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A 30 year-old woman who had had progressive systemic sclerosis for seven years was admitted to our hospital with a history of one week of increasing abdominal girth and one month's history of increasing peripheral oedema, especially in the lower limbs, and a weight loss of 10 kilograms in the course of five months. On admission she had oedema of the lower limbs, lower back and abdomen, and had ascites but no signs of peritonitis. An abdominal X-ray examination revealed distended bowels with elevated air fluid levels and pneumoperitoneum. The combination of the clinical and radiological findings, as well as the history, strongly suggested a diagnosis of pneumocystosis cystoides intestinalis as a complication to progressive systemic sclerosis. The symptoms improved on treatment and no signs of recurrence were found at follow-up after four years. We discuss the underlying pathology and management of this condition.
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