Year 2020 / Volume 112 / Number 8
Letter
Extensive colonic pneumatosis. Conservative or Surgical approach?

661

DOI: 10.17235/reed.2020.6825/2019

Leticia Pérez Santiago, Ricardo Gadea Mateo, Raquel Alfonso Ballester,

Abstract
Intestinal pneumatosis is a radiologic finding that consists of the presence of air in the intestinal wall. The etiology is extensive and can range from a benign entity to one that compromises the patients´ life. It is important to know and recognize the differences between them as the surgical management will depend on it. We report the case of an 82-year-old male diagnosed with a metastatic castration resistant prostate carcinoma, under chemotherapy with disease progression in treatment with high doses of intravenous morphics. The patient reported abdominal distension with constipation and no vomiting in the emergency department and a distended and tympanic abdomen, without generalized peritonitis was identified during physical examination. A blood analysis showed lactate levels of 0.9 mmol/L and a PCR of 4.2 mg/L without leukocytosis. An extensive colonic pneumatosis with minimum pneumoperitoneum without free fluid was confirmed by a computed tomography (CT) scan (Fig 1). A conservative approach with intravenous antibiotic and clinical surveillance was decided due to the fact that the patient was clinically stable without generalized peritonitis nor pathological findings in the supplementary blood tests. The clinical evolution was uneventful and the patient was discharged from hospital De la Serna et al. opted for a conservative approach for a patient with stage IV lung adenocarcinoma under chemotherapy treatment, who presented asymptomatic intestinal pneumatosis and subsequently made a full recovery. We also believe that the use of some chemotherapeutic agents may cause an increase in the permeability of the intestinal capillaries, allowing air to flow into the intestinal walls. Thus, resulting in this radiologic image, which is more a radiological finding than a disease. We think that a conservative initial attitude should be recommended in hemodynamically stable cases, without peritonitis and non-pathological blood analysis.
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References
Kirmanidis M, Boulas KA, Paraskeva A,et al. A. Extensive colonic pneumatosis in a patient on adjuvant chemotherapy after right colectomy for primary terminal ileum lymphoma: A decision-making process between surgical and non-surgical management.Int J Surg Case Rep. 2018;52:84-88. doi: 10.1016/j.ijscr.2018.09.050
Braumann C., Menenakos C., Jacobi C.A. Pneumatosis intestinalis—a pitfall for surgeons? Scand. J. Surg. 2005;94:47–50. DOI: 10.1177/145749690509400112
De la Serna S., Luna A.; De la Rosa H. Neumatosis intestinal y neumoperitoneo en contexto de tratamiento oncológico: un cambio de actitud. REV ESP ENFERM DIG 2018:110(1):68-69 DOI: 10.17235/reed.2017.5333/2017
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Pérez Santiago L, Gadea Mateo R, Alfonso Ballester R. Extensive colonic pneumatosis. Conservative or Surgical approach?. 6825/2019


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Publication history

Received: 16/12/2019

Accepted: 21/12/2019

Online First: 04/06/2020

Published: 30/07/2020

Article Online First time: 171 days

Article editing time: 227 days


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