Intestinal pneumatosis is a rare disease, the chief symptom of which is the presence in the intestinal wall containing gases cysts. The exact etiology is still unknown. Causes of pneumatization bowel can be iatrogenic (i.e., caused by actions of medical workers or medical procedures), and to be a consequence of various diseases.
The disease can occur after surgery on the ileum, after a colonoscopy, in chemotherapy treatment. Pneumatosis may be caused by chronic lung disease, diseases affecting connective tissue, as well as the consumption of sorbitol or lactulose ingestion; all contributing to the development of pneumatosis factors, doctors account for more than fifty. In recent years, cases of the appearance of cysts, located under the serous and mucous membranes of the intestine.
However, it remains unclear whether it is caused by microtrauma as a result of inspection of the bowel during barium enema or colonoscopy, or just the improvement of the methods of these studies have led to better detection of the disease.
Causes of bowel pneumatization
There are various theories as it occurs pneumatosis of the intestine. According to the mechanical theory, increased pressure in the cavity of the intestine causes the penetration of the intestinal gas through microcracks in the intestinal mucosa into the lymphatic channels, and then under the influence of peristaltic contractions of the gas just keeps on going. As there is increased pressure in the intestine? One of the reasons could be a bowel obstruction, caused by trauma, surgical operation or conduct of the colonoscopy. This theory, however, explains the presence in the contents of cysts of a large amount of hydrogen (up to 50%). For comparison, a normal intestinal gas is composed of not more than 14% of hydrogen.
Bacterial theory of the origin of pneumatosis of the intestine suggests that under the mucous membrane of the bacteria (Clostridium and Escherichia coli) in the process of life emit gas that is retained submucosal layer and lymphatic channels. Inflammation of tissues around the cysts evidence in favor of this theory. Confirmed by her experiments on animals in which injection was injected into the wall of the intestine bacteria. The gas contained in the resulting injection of the cysts has a high content of hydrogen. Bacterial theory is confirmed by the fact that after the animal was treated with antibiotic metronidazole, the disease gradually disappeared.
Pulmonary theory suggests that in patients with chronic pulmonary diseases such as asthma and chronic bronchitis, gas released as a result of rupture of the alveoli, passes through the mediastinum into the retroperitoneal space, and what enters through perivascular space in the intestinal wall. Pneumatosis may occur in some hereditary diseases characterized by disorders of the respiratory system (cystic fibrosis) and as a result of injury – barotrauma or after drainage of the pleural region in the treatment of pneumothorax or hydrothorax (accumulation of air or fluid in the pleural cavity).
Yet there are studies that revealed a connection between the occurrence of pneumatization of the intestines and medications from diabetes (inhibitors alpha-glucosidase). Under the influence of these drugs bacterial flora of the intestine begins to produce intestinal gas in large quantities.
In most cases, cysts are formed in the walls of the ileum (42%) and colon (36%); the rest suffer as a thin and thick intestine (22%). Bubbles in the intestinal wall can be the size of a pinhead up to 6-7 cm in diameter; they can be scattered on the inner surface of the intestine and in close contact with each other, forming a long line. Some cysts can be located on the stem and hang down into the abdominal cavity.
Symptoms of intestinal pneumatosis
Pneumatosis has no characteristic clinical symptoms. It is either asymptomatic, or patients complain of pain and bloating, flatulence, associated colic, diarrhea, and bleeding from the anus. In General, doctors are more inclined to think that the pneumatosis of the intestine is not a disease but a condition complicating the course of other diseases.
Pneumatosis may be due to the following diseases:
Necrotizing enterocolitis. Unfortunately, this is one of the most common severe diseases in neonates and infants, the development of which is especially prone to premature children and children with low birthweight. The exact cause of this disease is unknown; assumptions vary from infarction of the bowel to the infectious nature of the disease. Its symptoms – bloating, food intolerance, vomiting, blood in the stool, diarrhea, extreme temperature and pressure. The disease can be very different: in mild cases it ends without any consequences for the child, and in severe shown surgical treatment.
Heart disease. Intestinal pneumatosis is one of the signs of problems in the cardiovascular system. Typically, in the course of treatment the improvement of the patient’s condition is and pneumatosis.
A consequence of injuries. Falling off a bike, fighting, blows to the abdomen – all of which can lead to the development of pneumatization of the intestine.
The result of the destruction of the intestinal mucosa. The reason for this phenomenon can be peptic ulcer disease and chronic gastritis. Also contribute to damage to the inner surface of the intestine and development of the capable obstruction appendicitis, adhesions in the result of the operation on the bowel, diverticulitis, intussusception (introduction of the upper segment of the intestine into the lower; most common in infants), and so on.
Some hereditary diseases such as Hirschsprung’s disease. One of the symptoms of chronic constipation, caused by abnormal development of the colon in newborns.
Acute intestinal infection. They are called as viruses (rotavirus, parvovirus, Coxsackievirus, Echovirus) and bacteria (Salmonella, E. coli, Staphylococcus aureus) and parasites.
The acquired immunodeficiency syndrome. Pneumatosis of the intestine in AIDS, affects to a greater extent the caecum and colon. It is assumed that the immune deficiency causes depletion of lymphoid tissue and as a consequence, the defeat of the walls of the intestine.
At suspicion on intestinal pneumatosis can be conducted following tests:
Colonoscopy. It is prescribed to determine the presence or absence of damage of the colon. Pneumatization of the intestine is determined by the cysts. They can be as small, are abundant, or more rare and large (up to 3 cm in diameter), surrounded by reddened and inflamed intestinal mucosa. Cysts are normally destroyed during the biopsy. Recently, in connection with programs for preventive detection of colon cancer, the number of cases of intestinal pneumatosis grows – its presence detect even in patients with complete absence of symptoms of gastro-intestinal diseases.
X-ray examination. Even a simple x-ray of the digestive tract can detect pathological changes in the walls of the intestine. On x-ray pneumatosis of the intestine looks like some small bubbles or their accumulation in the form of grape bunches or strips.
Computed tomography or magnetic resonance imaging. Using these methods, you can determine the place where the intestinal wall is thickened and contains gas. CT more sensitive than plain x-ray, and is able to distinguish pneumatosis from the air in the lumen of the intestine or fatty tissue. In addition, when using a CT scan can determine the severity of the development of pneumatization of the intestine – for example, the greatly thickened walls of the intestine, whether there is fluid accumulation in the abdomen (ascites) and so on.
Pronounced intestinal pneumatosis and related complications
If cysts are many and they are large in size, their accumulation may lead to bowel obstruction. In severe cases, the gas pressure in the cysts is so great that it can cause rupture of the intestine, in which the gas and the contents of the intestine enters the abdominal cavity. As a result, the person may develop peritonitis, which is a disease dangerous to life. Also marked pneumatosis of the intestine is dangerous because organs adjacent to the affected area of intestine may be squeezed, which contributes to the development of adhesions.
Treatment of intestinal pneumatosis
As pneumatization bowel is not a separate disease but a consequence, you should treat the disease that affects and has developed pneumatosis. As a rule, in the treatment of pneumatosis gradually eroding. If the cause of the pneumatosis, the increased pressure in the abdominal region as a result of increased gas formation, your doctor may treat it with improves peristalsis drugs, laxatives, destination, diet and so on. If pneumatosis arose as a result of the infection, your doctor may suggest the patient to take anti-viral drugs and antibiotics.
If the size and number of cysts are such that they start to pose a danger by themselves, to treat pneumatosis is possible by means of oxygen respiratory therapy. Its principle of operation is as follows: the supply of oxygen increases saturation of blood with this gas and leads to an increase in pressure in the cysts. The oxygen displaces the gases from the cysts and subsequently metabolized by the body, which leads to a weakening and disappearance of signs of pneumatization of the intestine. To reduce the frequency of relapses oxygen therapy is recommended to place two days after the final disappearance of the cysts.
Treatment oxygen and respiratory therapy is as follows: the patient must put on a facial mask high-flow, she’s a Venturi mask. The mask comes in a mixture of oxygen (from a cylinder) and fed through the same valve mask normal air. The mask allows you to adjust the saturation of the air mixture with oxygen. Oxygen in high doses can be harmful, so during therapy the physician needs every day to measure the gas pressure in the blood and from time to time to do the patient a chest x-ray. The decrease in lung capacity is one of the symptoms of incipient oxygen toxicity.
Surgical treatment of intestinal pneumatosis
In especially severe cases of pneumatization of the intestine (e.g., the threat of peritonitis) can be assigned to surgical treatment. Do the operation, the doctor determines a set of attributes: the degree of pain, presence of diarrhea, temperature, whether there is bleeding from the anus, are lowered if the pressure and test results (including white blood cell count, amylase, lactic acid and other chemical compounds in the blood). Also, the doctor draws attention to the presence of complications the patient and the condition of his intestines.