01 February 2024 : Case report
[In Press] Conservative versus Surgical Treatment of Pneumatosis Intestinalis: Experience from a Multidisciplinary Center
Challenging differential diagnosis, Management of emergency care, Rare diseaseHuy Duc Tran1AB, Sang Thanh Tran1BC, Triet Minh Le1CF, Vinh Ngoc Truong Pham1ACE, Kien Trung Le1CF, An Trinh Ngoc Le1BCE, Viet Van Ung1ABF, Tan Danh Hoang1CDE, Thinh Huu Nguyen1AE
Am J Case Rep In Press; DOI: 10.12659/AJCR.943166
Available online: 2024-02-01, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Pneumatosis intestinalis (PI) is an uncommon condition that is not specific to any particular disease. Currently, there is no specific clinical guideline for treating and diagnosing PI. Furthermore, there are numerous causes of PI, which makes it difficult for clinicians – internal medicine physicians as well as surgeons – to take a clinical approach to diagnosis and treatment.
We present 3 clinical scenarios with PI. In the first patient there was a solitary image of PI, which was treated successfully with parenteral nutrition and intravenous antibiotics, and he was discharged after 5 days. The other 2 cases, which involve gas in the hepatic portal vein (HPVG), were handled in 2 distinct ways: surgically and conservatively. One needed diagnostic laparoscopy with necrotic segmentectomy and was discharged from the hospital on postoperative day 16. The last patient, received resuscitation treatment due to severe comorbidities and inability to tolerate surgery. After 3 days, abdominal CT scan revealed no signs of remaining PI. However, the patient was terminally discharged after 7 weeks of treatment due to septic shock caused by sacrococcygeal ulcer and urinary tract infection. By drawing comparisons among these 3 scenarios, we aim to highlight certain indicators for conservative treatment success.
PI with HPVG is a sign of severe prognosis, which often requires surgical intervention. However, the decision to manage conservatively or surgically depends on the patient’s condition and other criteria such as peritonitis, free fluid in the abdominal cavity, and the presence of shock. Physicians should also weigh the benefits and risks of surgical intervention in critically ill patients.
Keywords: Computed Tomography Angiography; Pneumatosis Cystoides Intestinalis; Portal Vein; Pulmonary Disease, Chronic Obstructive
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