Pneumatosis intestinalis
As pneumatosis intestinalis in medicine is a rare disease or in the radiology refers to a rare finding. The clinical picture is characterized by an accumulation of gas in the wall (intramural) of the digestive tract . The accumulation of gas can occur in different layers of the digestive organs. A distinction is made between subserous (below the serosa ) and submucosal (below the mucosa ) pneumatosis intestinalis. In addition, a classification can be made according to the organ affected, for example the intramural accumulation of gas in the large intestine (colon) is referred to as pneumatosis coli . Pneumatosis cystoides intestinalis is a special form .
The first use of the term pneumatosis intestinalis goes back to Lerner and Gazin in 1946.
Disease emergence
The development of pneumatosis intestinalis can have various causes. The mechanisms of how and when intramural gas accumulation occurs have not yet been conclusively clarified. There are various possible explanations. The most common causes are intestinal necrosis as a result of lack of oxygen ( ischemia ), necrotizing enterocolitis , volvulus or sepsis . Possible mechanical causes, i.e. as a result of increased intraluminal pressure , include gastric ulcer ( ulcus ventriculi ), pyloric stenosis and the annular pancreas . Intestinal pneumatosis can also develop in immunocompromised patients. It is assumed that the atrophy of Peyer's plaques - as a result of immunosuppression - is associated with a loss of the intestinal wall integrity. Secondarily, gas could then enter the intestinal wall.
Diagnosis and therapy
The diagnosis is made with the help of imaging tests. Pronounced intramural gas accumulations can already be diagnosed with a conventional X-ray of the abdomen (abdomen overview). In the case of low intramural gas accumulations or if the informative value of the intake is reduced, for example due to flatulence (meteorism), the finding can be false positive. The diagnostic method of choice is now computed tomography , with which a reliable distinction between intramural and extramural (outside the walls) gas accumulation is usually possible.
The therapy depends on the underlying cause or disease.
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- J. Trübenbach et al .: Cover picture: Pneumatosis intestinalis RöFo 01/99 online version
