Pneumatosis Coli



Pneumatosis Coli


Sharon K. Bihlmeyer, MD





Key Facts


Terminology



  • Synonym: Pneumatosis cystoides intestinalis


  • Presence of gas in bowel wall


  • Clinical sign of underlying disease process rather than disease entity itself


Etiology/Pathogenesis



  • Ischemic bowel


  • Necrotizing enterocolitis


  • Clostridium difficile colitis


  • Immunosuppressive therapy and steroids


  • Iatrogenic causes: Endoscopy, surgery


Clinical Issues



  • May be asymptomatic when found incidentally


  • Abdominal distension


  • Elevated lactic acid of > 2 mmol/L associated with > 80% mortality rate


Image Findings



  • Low-density linear or bubbly pattern of gas in bowel wall


Microscopic Pathology



  • Cysts within submucosa &/or subserosa


  • Giant cells lining rounded or cleft-like space


  • Fibrosis surrounding cysts


Top Differential Diagnoses



  • Diffuse emphysema


  • Lymphangioma of peritoneum


  • Granulomatous inflammation



    • Seen in Crohn disease or infection


  • Fat necrosis







Gross pathology photograph shows a cross section of the colon wall including intact mucosa image, overlying submucosa expanded by air bubbles image, and edema. Note the subserosal cysts image.






Hematoxylin & eosin shows colon mucosa and superficial submucosa. There is a layer of histiocytes image at the bottom corresponding to the cyst lining of pneumatosis.


TERMINOLOGY


Abbreviations



  • Pneumatosis coli (PC)


  • Pneumatosis intestinalis (PI)


  • Pneumatosis cystoides intestinalis (PCI)


Synonyms



  • Intestinal emphysema


  • Abdominal gas cysts


  • Cystic lymphopneumatosis


  • Peritoneal lymphopneumatosis


  • Intramural gas


Definitions



  • Presence of gas in bowel wall



    • Clinical sign of underlying disease process rather than disease entity itself


ETIOLOGY/PATHOGENESIS


Infectious Agents



  • Clostridium difficile


  • Clostridium perfringens


  • Clostridium septicum


  • AIDS


  • CMV


Drugs or Toxins



  • Immunosuppressive therapy and steroids



    • Thought to cause shrinkage of lymphoid tissue and compromise integrity of mucosa


  • α-glucosidase inhibitor


  • Lye ingestion


  • Lactulose


  • Drugs associated with ischemic colitis



    • Nasal decongestants, oral contraceptives, phenobarbital, cocaine, methamphetamines


Iatrogenic



  • Endoscopy


  • Surgery


  • Insertion of percutaneous feeding tube


Theories of Pathogenesis



  • Mechanical theory



    • Dissection of intestinal gas into bowel wall occurs through damaged or interrupted intestinal mucosa


    • Gas may accumulate when intraluminal pressure ↑



      • Proximal to obstruction


      • Repeated vomiting


      • Blunt abdominal trauma


  • Bacterial (microbiological) theory



    • Gas-forming bacilli enter mucosa and produce gas within wall



      • However, fluid cultures have been found to be sterile


    • Supported by high hydrogen content in gas as bacteria produce hydrogen


Other

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Jul 6, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Pneumatosis Coli

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