[Pneumatosis cystoides intestinorum et mesenterii. Case report].
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A case of pneumatosis cystoides Coli located in the sigmoid in an adult is reported, with emphasis on US and CT aspects. CT patterns of pneumatosis cystoides Coli are highly significative; particularly attenuation values measured in the endoluminal polypoid images are characteristics and represent an interesting contribution to the diagnosis of this disease.
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A patient with pneumatosis coli presenting as an abdominal mass is reported. A review of the pathogenesis and treatment is also covered.
Necrotizing enterocolitis is uncommon among term infants. In this group, necrotizing enterocolitis has been associated with two risk factors: polycythemia and umbilical catheterization. During a randomized trial of partial plasma exchange transfusion for treatment of polycythemia, an increased risk of gastrointestinal problems was noted. Eight hyperviscous patients treated with partial plasma exchange transfusion, no symptomatically treated patients, and no control infants developed typical necrotizing enterocolitis (blood in the stools, pneumatosis, and systemic signs). The incidence of necrotizing enterocolitis was significantly greater among patients treated with exchange transfusion compared with patients treated symptomatically or control subjects (P less than .001).
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Pneumatosis coli in a 72-year-old woman caused severe incapacitation by diarrhoea and faecal incontinence. Treatment consisted of oxygen via a Venturi mask to give arterial oxygen tension c. 32.5 kPa. It was well tolerated and resulted in symptomatic and radiologic cure within 7 days. Knowledge of this treatment and correct diagnosis are important for avoidance of unnecessary surgery.
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The authors report 2 radiographic findings that have not previously been described in patients with cystic fibrosis: (1) the linear form of pneumatosis coli (2) large pancreatic concretions which resembled the pancreatic calcificaitons of hereditary pancreatitis. The patient with pancreatic calcification also had labile diabetes and episodes of ketoacidosis, unusual complications of cystic fibrosis.
This report is of five cases of primary pneumatosis coli, four of whom underwent five surgical resections. Follow-up was from nine months to ten years with one recurrence nine years after sigmoid colectomy. This experience indicates that primary pneumatosis coli is now more common than pneumatosis cystoides intestinales of the small bowel. We also feel that there is a place for surgical resection of symptomatic pneumatosis coli even in the absence of acute complications.
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Two patients with a giant cyst of the sigmoid colon are presented. The literature is reviewed and the clinical features, differential diagnosis and treatment are discussed.
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