[Primary pneumatosis intestinalis: its clinical significance, radiologic and endoscopic findings].
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A case of emphysematous pyelonephritis is reported. The initially puzzling plain abdominal radiographs simulated intestinal obstruction and pneumatosis intestinalis. Resolution was later confirmed sonographically.
Five patients who developed pneumatosis intestinalis in the course of a cytomegalo virus (CMV) infection after cadaveric kidney transplantation are described. Based on the fact that CMV is known to cause intestinal ulcers, we postulate a causal relationship between CMV and pneumatosis intestinalis.
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The finding of a colo-colic intussusception with pneumatosis intestinalis is described with imaging. This was confirmed at surgery together with pathological confirmation of pneumatosis intestinalis. This rare association occurred in an infant with Peters' anomaly who was taking oral steroids.
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Four patients with pneumatosis intestinalis involving the unbypassed functioning bowel after jejunoileal bypass for obesity are reported. Previous publications of pneumatosis intestinalis after jejunoileal bypass discussed involvement only of the bypassed defunctionalized bowel. Symptomatology can range from mild to severe. The treatment of pneumatosis intestinalis is conservative. The specific etiology of the pneumatosis in this group of patients is not known.
A benign episode of pneumatosis intestinalis developed in a 54-year old black woman with rapidly progressive systemic lupus erythematosus. This case illustrates that pneumatosis intestinalis in association with the various collagen diseases can have disparate prognostic implications.
Four immunologically compromised children, two with acute lymphoblastic leukemia who received immunosuppressive therapy, one with X-linked agammaglobulinemia, and one with chronic granulomatous disease of childhood, displayed both the pulmonary and gastrointestinal mechanisms that led to pneumatosis intestinalis. Consideration of both the basic disease and the immediate clinical circumstances that surround the development of intramural air are helpful in the determination of the significance of pneumatosis intestinalis in individual patients.
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Six cases of intestinal pneumatosis following the jejunoileal bypass procedure are reported. Although the radiographic pattern of the pneumatosis intestinalis suggested severe disease, such as bowel infarction or necrotizing enterocolitis, all cases followed a benign course.
To investigate whether radiographic findings could be used to predict pan-necrosis (necrosis of 75% or more of the jejunum, ileum, and colon), we reviewed the serial abdominal radiographs and clinical records of 147 infants with necrotizing enterocolitis. Pan-necrosis occurred in 29 infants (20%) and was always fatal. The presence and degree of pneumatosis intestinalis, pneumoperitoneum and portal venous gas were studied. Pan-necrosis occurred least frequently in infants with mild or moderate pneumatosis intestinalis (8% and 12%, respectively), and with moderate frequency in those with pneumoperitoneum (33%). Pan-necrosis was found most frequently in infants with severe pneumatosis intestinalis (56%), portal venous gas (61%), or the combination of severe pneumatosis intestinalis and portal venous gas (79%). The mortality rates in these three groups were 63%, 65%, and 86%, respectively. Thus, infants with the worst outcome (those who develop pan-necrosis) can be identified on plain films by detection of severe pneumatosis intestinalis and portal venous gas.
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