Welche Bedeutung hat die Diagnose „Pneumatosis intestinalis“ und „Portal Gas“ für den Chirurgen?

Editorial

Als Pneumatosis intestinalis (PI) wird das Vorliegen von Gasansammlungen in der Wand des Gastrointestinaltraktes bezeichnet. Diese sowie das Vorliegen von Portal Gas (PG), Gasansammlungen im portalvenösen System, sind per se keine eigenständigen Krankheitsbilder, sondern sind primär nur Symptome, die eine Vielzahl von Ursachen haben können [1] [2] [3] [4] [8] [11] [16] [20] [21] [22] [24] [25] [27] [29] [33] [34] [35] [39] [41] [45] [46] [48] [51] [52] [66] [67] [69] [71] [72] [73] [75] [76] [78] [79] [82] [83] [85] [87] [88] . In bis zu 43 % der Fälle treten diese jedoch assoziiert mit einer mesenterialen Ischämie und dann mit einer Mortalitätsrate von bis zu 75 % auf [50] [55] .

Literatur

• 1 Ahrar K, Watkins G E, Gardiner G. Colocolic intussusception caused by pneumatosis cystoides coli.  Abdom Imaging. 1997;  22 392-394
• 2 Azami Y. Paralytic ileus accompanied by pneumatosis cystoides intestinalis after acarbose treatment in an elderly diabetic patient with a history of heavy intake of maltitol.  Intern Med. 2000;  39 826-829
• 3 Azimuddin K, Bourne R. Pneumatosis cystoides intestinalis in a case of sigmoid volvulus.  Br J Hosp Med. 1997;  57 468-469
• 4 Bahador A, Bagheri M H. Pneumatosis intestinalis associated with duodenal atresia.  Pediatr Radiol. 1998;  28 927
• 5 Bodewes H W, Puylaert J B. Ultrasound in detection of portal venous gas in adults.  Gastrointest Radiol. 1991;  16 35-37
• 6 Bomelburg T, von Lengerke H J. Intrahepatic and portal venous gas detected by ultrasonography.  Gastrointest Radiol. 1992;  17 237-240
• 7 Buras R, Guzzetta P, Avery G et al. Acidosis and hepatic portal venous gas: indications for surgery in necrotizing enterocolitis.  Pediatrics. 1986;  78 273-277
• 8 Capitanio M A, Greenberg S B. Pneumatosis intestinalis in two infants with rotavirus gastroenteritis.  Pediatr Radiol. 1991;  21 361-362
• 9 Caudill J L, Rose B S. The role of computed tomography in the evaluation of pneumatosis intestinalis.  J Clin Gastroenterol. 1987;  9 223-226
• 10 Chan S C, Wan Y L, Cheung Y C et al. Computed tomography findings in fatal cases of enormous hepatic portal venous gas.  World J Gastroenterol. 2005;  11 2953-2955
• 11 Cho K C, Simmons M Z, Baker S R et al. Spontaneous dissection of air into the transverse mesocolon during double-contrast barium enema.  Gastrointest Radiol. 1990;  15 76-77
• 12 Christl S U, Gibson G R, Murgatroyd P R et al. Impaired hydrogen metabolism in pneumatosis cystoides intestinalis.  Gastroenterology. 1993;  104 392-397
• 13 Connor R, Jones B, Fishman E K et al. Pneumatosis intestinalis: role of computed tomography in diagnosis and management.  J Comput Assist Tomogr. 1984;  8 269-275
• 14 Daly B D, Guthrie J A, Couse N F. Pneumoperitoneum without peritonitis.  Postgrad Med J. 1991;  67 999-1003
• 15 Dennis M A, Pretorius D, Manco-Johnson M L et al. CT detection of portal venous gas associated with suppurative cholangitis and cholecystitis.  AJR Am J Roentgenol. 1985;  145 1017-1018
• 16 Duncan B, Barton L L, Eicher M L et al. Medication-induced pneumatosis intestinalis.  Pediatrics. 1997;  99 633-636
• 17 Ecker J A, Williams R G, Clay K L. Pneumatosis cystoides intestinalis – bullous emphysema of the intestine. A review of the literature.  Am J Gastroenterol. 1971;  56 125-136
• 18 Ellis B W. Symptomatic treatment of primary pneumatosis coli with metronidazole.  Br Med J. 1980;  280 763-764
• 19 Faberman R S, Mayo-Smith W W. Outcome of 17 patients with portal venous gas detected by CT.  AJR Am J Roentgenol. 1997;  169 1535-1538
• 20 Feczko P J, Mezwa D G, Farah M C et al. Clinical significance of pneumatosis of the bowel wall.  Radiographics. 1992;  12 1069-1078
• 21 Fenton L Z, Buonomo C. Benign pneumatosis in children.  Pediatr Radiol. 2000;  30 786-793
• 22 Florin T H. Alkyl halides, super hydrogen production and the pathogenesis of pneumatosis cystoides coli.  Gut. 1997;  41 778-784
• 23 Florin T H, Hills B A. Does counterperfusion supersaturation cause gas cysts in pneumatosis cystoides coli, and can breathing heliox reduce them?.  Lancet. 1995;  345 1220-1222
• 24 Franquet T, Gonzalez A. Gastric and duodenal pneumatosis in a child with annular pancreas.  Pediatr Radiol. 1987;  17 262
• 25 Gagliardi G, Thompson I W, Hershman M J et al. Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature.  Int J Colorectal Dis. 1996;  11 111-118
• 26 Galandiuk S, Fazio V W. Pneumatosis cystoides intestinalis. A review of the literature.  Dis Colon Rectum. 1986;  29 358-363
• 27 Galandiuk S, Fazio V W, Petras R E. Pneumatosis cystoides intestinalis in Crohn’s disease. Report of two cases.  Dis Colon Rectum. 1985;  28 951-956
• 28 Goodman R A, Riley III T R. Lactulose-induced pneumatosis intestinalis and pneumoperitoneum.  Dig Dis Sci. 2001;  46 2549-2553
• 29 Goske M J, Goldblum J R, Applegate K E et al. The “circle sign”: a new sonographic sign of pneumatosis intestinalis – clinical, pathologic and experimental findings.  Pediatr Radiol. 1999;  29 530-535
• 30 Grieve D A, Unsworth I P. Pneumatosis cystoides intestinalis: an experience with hyperbaric oxygen treatment.  Aust N Z J Surg. 1991;  61 423-426
• 31 Griffith J, Apostolakos M, Salloum R M. Pneumatosis intestinalis and gas in the portal venous system.  J Gastrointest Surg. 2006;  10 781-782
• 32 Gruenberg J C, Batra S K, Priest R J. Treatment of pneumatosis cystoides intestinalis with oxygen.  Arch Surg. 1977;  112 62-64
• 33 Hashimoto S, Saitoh H, Wada K et al. Pneumatosis cystoides intestinalis after chemotherapy for hematological malignancies: report of 4 cases.  Intern Med. 1995;  34 212-215
• 34 Hayakawa M, Gando S, Kameue T et al. Abdominal compartment syndrome and intrahepatic portal venous gas: a possible complication of endoscopy.  Intensive Care Med. 2002;  28 1680-1681
• 35 Hayakawa T, Yoneshima M, Abe T et al. Pneumatosis cystoides intestinalis after treatment with an alpha-glucosidase inhibitor.  Diabetes Care. 1999;  22 366-367
• 36 Heng Y, Schuffler M D, Haggitt R C et al. Pneumatosis intestinalis: a review.  Am J Gastroenterol. 1995;  90 1747-1758
• 37 Hoer J, Truong S, Virnich N et al. Pneumatosis cystoides intestinalis: confirmation of diagnosis by endoscopic puncture a review of pathogenesis, associated disease and therapy and a new theory of cyst formation.  Endoscopy. 1998;  30 793-799
• 38 Hollerweger A, Rettenbacher T. Detection of portal venous gas on sonography, but not on CT.  Eur Radiol. 2003;  13 Suppl. 4 L 251-L 253 , author reply L 254
• 39 Holt R W, Dekker J. Gastric pneumatosis intestinalis associated with cholangiocarcinoma.  South Med J. 1986;  79 79-80
• 40 Hoover E L, Cole G D, Mitchell L S et al. Avoiding laparotomy in nonsurgical pneumoperitoneum.  Am J Surg. 1992;  164 99-103
• 41 Horiuchi A, Akamatsu T, Mukawa K et al. Case report: Pneumatosis cystoides intestinalis associated with post-surgical bowel anastomosis: a report of three cases and review of the Japanese literature.  J Gastroenterol Hepatol. 1998;  13 534-537
• 42 Iannitti D A, Gregg S C, Mayo-Smith W W et al. Portal venous gas detected by computed tomography: is surgery imperative?.  Dig Surg. 2003;  20 306-315
• 43 Ihara E, Harada N, Motomura S et al. A new approach to Pneumatosis cystoides intestinalis by target air-enema CT.  Am J Gastroenterol. 1998;  93 1163-1164
• 44 Jamart J. Pneumatosis cystoides intestinalis. A statistical study of 91 cases.  Acta Hepatogastroenterol (Stuttg). 1979;  26 419-422
• 45 Jensen R, Gutnik S H. Pneumatosis cystoides intestinalis: a complication of colonoscopic polypectomy.  S D J Med. 1991;  44 177-179
• 46 Kelly Jr B S, Meyers P, Choe K A et al. Traumatic pneumatosis cystoides intestinalis with portal venous air embolism.  J Trauma. 1997;  42 112-114
• 47 Keyting W S, McCarver R R, Kovarik J L et al. Pneumatosis intestinalis: a new concept.  Radiology. 1961;  76 733-741
• 48 Khouri M R, Levine M S, Dabezies M et al. Benign pneumoperitoneum in a patient with celiac sprue.  J Clin Gastroenterol. 1989;  11 70-72
• 49 Kinoshita H, Shinozaki M, Tanimura H et al. Clinical features and management of hepatic portal venous gas: four case reports and cumulative review of the literature.  Arch Surg. 2001;  136 1410-1414
• 50 Knechtle S J, Davidoff A M, Rice R P. Pneumatosis intestinalis. Surgical management and clinical outcome.  Ann Surg. 1990;  212 160-165
• 51 Koss L G. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis); an analysis with a report of a case and a critical review of the literature.  AMA Arch Pathol. 1952;  53 523-549
• 52 Kreiss C, Forohar F, Smithline A E et al. Pneumatosis intestinalis complicating C. difficile pseudomembranous colitis.  Am J Gastroenterol. 1999;  94 2560-2561
• 53 Kriegshauser J S, Reading C C, King B F et al. Combined systemic and portal venous gas: sonographic and CT detection in two cases.  AJR Am J Roentgenol. 1990;  154 1219-1221
• 54 Kunin N, Verbrackel L, Morin-Chouarbi V et al. The association of Pneumatosis intestinalis and portal venous gas.  Presse Med. 2003;  32 1892-1893
• 55 Liebman P R, Patten M T, Manny J et al. Hepatic-portal venous gas in adults: etiology, pathophysiology and clinical significance.  Ann Surg. 1978;  187 281-287
• 56 Luks F I, Chung M A, Brandt M L et al. Pneumatosis and pneumoperitoneum in chronic idiopathic intestinal pseudoobstruction.  J Pediatr Surg. 1991;  26 1384-1386
• 57 Maher M M, Tonra B M, Malone D E et al. Portal venous gas: detection by gray-scale and Doppler sonography in the absence of correlative findings on computed tomography.  Abdom Imaging. 2001;  26 390-394
• 58 Maltz C. Benign pneumoperitoneum and pneumatosis intestinalis.  Am J Emerg Med. 2001;  19 242-243
• 59 Marigold J H. Pneumatosis cystoides coli and chloral hydrate.  Gut. 1998;  42 899-900
• 60 Marshak R H, Lindner A E, Maklansky D. Pneumatosis cystoides coli.  Gastrointest Radiol. 1977;  2 85-89
• 61 Masterson J S, Fratkin L B, Osler T R et al. Treatment of pneumatosis cystoides intestinalis with hyperbaric oxygen.  Ann Surg. 1978;  187 245-247
• 62 McFadden S, Dunlop W E. Hepatic portal venous gas in adults: importance of ultrasonography in early diagnosis and survival.  Can J Surg. 1989;  32 297-298
• 63 Miralbes M, Hinojosa J, Alonso J et al. Oxygen therapy in pneumatosis coli. What is the minimum oxygen requirement?.  Dis Colon Rectum. 1983;  26 458-460
• 64 Mularski R A, Sippel J M, Osborne M L. Pneumoperitoneum: a review of nonsurgical causes.  Crit Care Med. 2000;  28 2638-2644
• 65 Muscari F, Suc B, Lagarrigue J. Hepatic portal venous gas: is it always a sign of severity and surgical emergency?.  Chirurgie. 1999;  124 69-72
• 66 North J HJr, Nava H R. Pneumatosis intestinalis and portal venous air associated with needle catheter jejunostomy.  Am Surg. 1995;  61 1045-1048
• 67 Parra J A, Acinas O, Bueno J et al. An unusual form of pneumatosis intestinalis associated with appendicitis.  Br J Radiol. 1998;  71 326-328
• 68 Peloponissios N, Halkic N, Pugnale M et al. Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases.  Arch Surg. 2003;  138 1367-1370
• 69 Quirke T E. Hepatic-portal venous gas associated with ileus.  Am Surg. 1995;  61 1084-1086
• 70 Read N W, Al-Janabi M N, Cann P A. Is raised breath hydrogen related to the pathogenesis of pneumatosis coli?.  Gut. 1984;  25 839-845
• 71 Sackier J M, Smith E J, Wood C B. Cystic pneumatosis in coeliac disease.  Gut. 1988;  29 852-855
• 72 Samson V E, Brown W R. Pneumatosis cystoides intestinalis in AIDS-associated cryptosporidiosis. More than an incidental finding?.  J Clin Gastroenterol. 1996;  22 311-312
• 73 Sato A, Yamaguchi K, Nakajima T. A new health problem due to trichloroethylene: pneumatosis cystoides intestinalis.  Arch Environ Health. 1987;  42 144-147
• 74 Schulze C G, Blum U, Haag K. Hepatic portal venous gas. Imaging modalities and clinical significance.  Acta Radiol. 1995;  36 377-380
• 75 Sequeira W. Pneumatosis cystoides intestinalis in systemic sclerosis and other diseases.  Semin Arthritis Rheum. 1990;  19 269-277
• 76 Seto T, Koide N, Taniuchi N et al. Pneumatosis cystoides intestinalis complicating carcinoma of the small intestine.  Am J Surg. 2001;  182 287-288
• 77 Sharma R, Tepas J J3rd, Hudak M L et al. Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis.  J Pediatr Surg. 2005;  40 371-376
• 78 Shuck J M, Malan L J, Hammar M D. Pneumatosis cystoides intestinals due to blunt abdominal trauma.  J Trauma. 1974;  14 435-440
• 79 Sicard G A, Vaughan R, Wise L. Pneumatosis cystoides intestinalis: an unusual complication of jejunoileal bypass.  Surgery. 1976;  79 480-484
• 80 Smerud M J, Johnson C D, Stephens D H. Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases.  AJR Am J Roentgenol. 1990;  154 99-103
• 81 St. Peter S D, Abbas M A, Kelly K A. The spectrum of pneumatosis intestinalis.  Arch Surg. 2003;  138 68-75
• 82 Tak P P, Van Duinen C M, Bun P et al. Pneumatosis cystoides intestinalis in intestinal pseudoobstruction. Resolution after therapy with metronidazole.  Dig Dis Sci. 1992;  37 949-954
• 83 Tang M L, Williams L W. Pneumatosis intestinale in children with primary combined immunodeficiency.  J Pediatr. 1998;  132 546-549
• 84 Vernacchia F S, Jeffrey R B, Laing F C et al. Sonographic recognition of pneumatosis intestinalis.  AJR Am J Roentgenol. 1985;  145 51-52
• 85 Wiesner W, Mortele K J, Glickman J N et al. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome.  AJR Am J Roentgenol. 2001;  177 1319-1323
• 86 Williams N M, Watkin D F. Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas.  Postgrad Med J. 1997;  73 531-537
• 87 Yale C E, Balish E, Wu J P. The bacterial etiology of pneumatosis cystoides intestinalis.  Arch Surg. 1974;  109 89-94
• 88 Zimmerman A L, Gupta J K, Ingegno A P. Pneumatosis coli following treatment with lactulose.  NY State J Med. 1979;  79 1896-1899