The spectrum of pneumatosis intestinalis in the adult.A surgical dilemma

Pneumatosis intestinalis(PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic significance nowadays has to be cross-referenced to the nature of the underlying condition.Multiple mechanisms of pathogenesis have been debated and multiple causes have been detected during the years. All this contributes to creating a broad range of clinical and radiological presentations. The management of patients presenting PI is related to the determining cause if it is identified. Otherwise, in particular if an association with portal venous gas and/or pneumoperitoneum is present, the eventual decision between surgery and non-operative management is challenging,even for stable patients, since this clinical condition is traditionally associated to intestinal ischemia and consequently to pending clinical collapse if not treated.Considering the wide variety of origin and outcomes, PI still remains for surgeons a demanding clinical entity. The manuscript is an updated narrative review and gives some suggestions that may help make the decisional process easier,identifying patients who can benefit from surgical intervention and those who can benefit from non-operative management avoiding unnecessary procedures.

Pneumatosis Cystoides Intestinalis Complicated during Chemotherapy for Pulmonary Nontuberculous Mycobacterial Disease

Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of gas in the intestinal wall. Aim: We report two rare cases of PCI that are complicated during the chemotherapy for pulmonary nontuberculous mycobacterial (NTM) disease. Case Presentation: In this report, we described two cases (a 72-year-old woman and a 60-year-old woman) of PCI that appeared during the combined chemotherapy consisting of rifampicin, ethambutol and clarithromycin. Because there were few clinical symptoms and increased inflammatory responses, the diagnosis of PCI was delayed. However, there were fortunately no severe complications in both cases. Conclusion: Respiratory physicians should be aware of the potential development of PCI in patients during the chemotherapy for pulmonary NTM disease. It is important to detect PCI in the early stage through radiological examinations to avoid severe complications.

A systematic analysis of pneumatosis cystoids intestinalis

AIM:To increase the understanding,diagnosis and treatment of pneumatosis cystoides intestinalis(PCI)and to find the characteristics and potential cause of the disease in China.METHODS:We report here one case of PCI in a 70-year-old male patient who received a variety of treatment methods.Then,we systematically searched the PCI eligible literature published from an available Chinese database from May 2002 to May 2012,including CBM,CBMDisc,CMCC,VIP,Wanfang,and CNKI.The key words were pneumatosis cystoides intestinalis,pneumatosis,pneumatosis intestinalis,pneumatosis coli and mucosal gas.The patients' information,histories,therapies,courses,and outcomes were reviewed.RESULTS:The study group consisted of 239 PCI cases(male:female = 2.4:1)from 77 reported incidents.The mean age was 45.3 ± 15.6 years,and the median illness course was 6 mo.One hundred and sixty patients(66.9%)were in high altitude areas.In addition,43.5%(104/239)of the patients had potential PCI-related disease,and 16.3% had complications with intestinal obstruction and perforation.The most common symptom was abdominal pain(53.9%),followed by diarrhea(53.0%),distention(42.4%),nausea and vomiting(14.3%),bloody stool(12.9%),mucous stool(12.0%)and constipation(7.8%).Most multiple pneumocysts developed in the submucosa of the colon(69.9%).The efficacy of the treatments by combined modalities,surgery,endoscopic treatment,conservative approach,oxygen,and antibiotics were 100%,100%,100%,93.3%,68.3% and 26.3%,respectively.CONCLUSION:PCI can be safely managed by conservative treatments,presents more frequently in males,in the large bowel and submucosa,than in females,in the small intestine and subserosa.High altitude residence maybe associated with the PCI etiology.

Gastrointestinal sarcoidosis associated with pneumatosis cystoides intestinalis

A 39-year-old male reported fevers,weight loss,watery loose stools,and decreased visual acuity in his right eye over the prior five years.He was pancytopenic,had an elevated American council on exercise level,total bilirubin,and alkaline phosphatase.Computed tomography revealed massive hepatosplenomegaly and emphysematous lung changes.Liver biopsy showed non caseating granulomas.The patient was diagnosed with extrapulmonary sarcoidosis and was treated with prednisone.The patient symptomatically improved but 5 mo later presented with abdominal pain caused by perforation of the cecum.He underwent a cecectomy and pathology revealed pneumatosis cystoides intestinalis.This represents the first reported association between pneumatosis cystoides intestinalis and sarcoidosis.The etiology of pneumatosis cystoides intestinalis in this case was likely multifactorial and involved both effects of the corticosteroids as well as the advanced nature of the gastrointestinal sarcoidosis.Furthermore this case has the unique features of emphysematous lung changes and pancytopenia which are uncommon with sarcoidosis.

Pneumatosis intestinalis with obstructing intussusception:A case report and literature review

Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and review the literatures regarding PI with intussusception. A 20-year-old man presented at our hospital with a 3-d intermittent lower abdominal pain history. He underwent steroid therapy for membranoproliferative glomerulonephritis for 4 years. Computed tomography revealed ascending colon intussusception with air within the wall. Intraoperative colonoscopy revealed numerous soft polypoid masses with normal overlying mucosa and right hemicolectomy was performed. Histological examination of colonic wall sections revealed large cysts in the submucosal layer. The pathological diagnosis was PI. Nine cases of intussusception associated with primary PI have been reported. Although primary PI often represents a benign condition that should not be considered as an argument for surgery,if the case involves intussusception and obstruction,emergent laparotomy should be considered.

Anti-microsporidial effect of thymoquinone on Encephalitozoon intestinalis infection in vitro

Objective:To evaluate the anti-microsporidial effects of the active component of Nigella sativa seeds,thymoquinone,against Encephalitozoon intestinalis using an in vitro model.Methods:Anti-microsporidial effect of thymoquinone against Encephalitozoon intestinalis was evaluated by using various concentrations of thymoquinone(0,1,5,10,15,20,30,35,and 40μM)and sterile dimethyl sulfoxide.Real time PCR was used to evaluate the inhibitory effects of thymoquinone on the life cycle of Encephalitozoon intestinalis.Results:The cytotoxic effect of thymoquinone on HEK293 cell line was observed with 30,35,and 40μM concentrations of thymoquinone after 24,48,and 72 hours of incubation.It was observed that 10,15,20,and 30μM concentrations of thymoquinone decreased the spore density compared with the control;however,it was significant only at 30μM.Conclusions:Thymoquinone shows potent anti-microsporidial effects against Encephalitozoon intestinalis in the in vitro model;however,the toxic concentrations of thymoquinone are also toxic to the host cells.

Symptomatic pneumatosis intestinalis(including portal venous gas) after laparoscopic total colectomy

The development of intramural intestinal gas may indi-cate a serious postoperative complication and thereforeany radiological indication of such "pneumatosis intes-tinalis"(PI) in an unwell patient after surgery shouldput the clinical team on high-alert. However immedi-ate recourse to relook laparotomy may not be alwaysnecessary and, further, in some cases may possiblyaccelerate the deterioration especially if it proves to benon-therapeutic. Careful and close clinical monitoring,as is described in this clinical report, may allow discrimi-native identification of those in whom this finding is infact transient and therefore benign and who thereforecan be successfully treated without operative re-inter-vention. We describe the presenting features and back-ground scenario of PI early after laparoscopic total col-ectomy for medically refractory, severe ulcerative colitisand detail the critical postoperative decision pivots.

Unusual radiological finding of lethal pneumatosis intestinalis and portomesenteric vein gas

Pneumatosis intestinalis and portomesenteric vein gas are rare and potentially severe radiological findings that occur both in pediatric and adult populations.They actually are radiographic signs of underlying intra-abdominal pathology,abnormality or diagnostic medical interference.If combined with other radiological or clinical signs of intestinal ischemia or sepsis,the prognosis is dismal and urgent laparotomy is mandatory.We report two cases of surgical treatment with ominous outcome in an effort to characterize this finding correctly as an absolute surgical indication or as an additional diagnostic criterion that simply marks a further breakdown of the systems in patients with a long list of severe medical conditions.

The enriched gut commensal Faeciroseburia intestinalis contributes to the anti-metabolic disorders effects of the Ganoderma meroterpene derivative

Previous study demonstrated that Ganoderma meroterpene derivative(GMD)increased the abundance of butyrate-producing bacteria in gut and subsequently delivered anti-metabolic disorder effect of host.To specify the key commensal bacteria associating with the beneficial effects,we tried to isolate and compare the microbiota from the cecal samples of GMD-and vehicle-treated ob/ob mice,and further identified butyrate-producing bacterial strains.It was found that Faeciroseburia intestinalis was enriched and 11 strains affiliated to F.intestinalis were cultivated from the gut of GMD-treated mice.In vitro assay attested butyrate production by representative strain of F.intestinalis.Oral administration with F.intestinalis further demonstrated its benefits on regulating hyperglycemia and hyperlipidemia,on decreasing plasma lipopolysaccharide(LPS)and inflammation,and on improving hepatic injuries.Treatment with F.intestinalis effectively enhanced the level of gut butyrate,which subsequently ameliorated the intestinal barrier function and activated epithelial PPAR-γ signaling pathway to regulate microbiome homeostasis in gut.Our study demonstrated that the causal relationship between the butyrate-producing bacteria and the GMD's therapeutic effects and confirmed the important function of the butyrate-producing F.intestinalis in maintaining host metabolism homeostasis.

In vitro antimicrobial activities of methanolic extract from marine alga Enteromorpha intestinalis

Objective:To extract the bioactive compound from Enteromorpha intestinalis(E. intestinalis) and determine its in vitro antimicrobial activity. Methods: E. intestinalis was extracted by methanol and subjected to antimicrobial screening. The antimicrobial activity was studied by using disc diffusion and broth dilution method. The effect of the extract on the growth profile of the bacterial was also examined via time-kill assay. Microscopy observations using SEM was done to determine the major alterations in the microstructure of methicillin-resistant Staphylococcus aureus(MRSA). Results: The results showed methanolic extract of E. intestinalis exhibited a favourable antimicrobial activity against tested bacteria with produced inhibition zone ranging from 8.0-19.0 mm. However, all the tested fungi and yeast were resistant to the extract treatment. Time kill assay suggested that methanolic extract of E. intestinalis had completely inhibited MRSA growth and also exhibited prolonged antibacterial activity. The main abnormalities noted from the microscopic observations were the structural deterioration in the normal morphology and complete collapsed of the bacteria cells after 36 h of treatment. Conclusions: The significant antibacterial activity shown by crude extract suggested its potential against MRSA infection. The extract may have potential to develop as antibacterial agent in pharmaceutical use.

Pneumatosis cystoides intestinalis associated with toxic epidermal necrolysis: A case report

Toxic epidermal necrolysis(TEN) is a severe adverse drug reaction, which is characterized by erythema, blisters, and/or erosions of the mucous membranes and skin, but intestinal involvement is rare. In contrast, pneumatosis cystoides intestinalis(PCI) is a rare condition associated with a wide variety of underlying diseases, but to date no patient has presented with PCI associated with TEN. A 55-year-old man was admitted to intensive care unit for treatment of TEN caused by phenobarbital. On day 8 after admission, he presented with progressive abdominal distention and hypotension. Computed tomography(CT) showed gas in the superior mesenteric vein and air filled cysts in the walls of the small intestine. He was suspected of having septic shock due to PCI. As there were no indications of bowel ischemia or necrosis, the patient was managed conservatively with antibiotics and oxygen therapy. On day 10 after admission, he was weaned off catecholamines, with CT on day 11 showing complete resolution of gas in the superior mesenteric vein and air filled cysts. To our knowledge, this article describes the first patient presenting with PCI associated with TEN.

Pneumatosis intestinalis and pneumoperitoneum on computed tomography:Beware of non-therapeutic laparotomy

Pneumatosis intestinalis(PI) is defined as gas within the gastrointestinal wall and is associated with a variety of disorders.As a concurrent occurrence with pneumoperitoneum,it can easily to be mistaken for bowel ischemia with perforated peritonitis.In fact,air dissection or rupture from subserosal cysts may be the cause of intraperitoneal and intraluminal free air,with clinical symptoms such as abdominal pain and fullness occurring as a result.We hereby report a case of an 82-year-old male with a history of chronic obstructive pulmonary disease who was diagnosed with bowel ischemia and received emergency laparotomy because of the appearance of PI and pneumoperitoneum on abdominal computed tomography scan.However,no perforated hollow organ or necrotic bowel segment was found,only diffusely distributed massive intraperitoneal air and PI of gastrointestinal tract.The laparotomy seemed non-therapeutic for this patient.This is significant warning for clinicians to differentiate the associated conditions of PI,and to evaluate whether or not emergency surgery is necessary.

Pneumatosis intestinalis after systemic chemotherapy for colorectal cancer:A case report

BACKGROUND Pneumatosis intestinalis(PI),also known as intramural gas in the small intestine,is a rare condition encountered by patients with cancer after receiving chemotherapy.CASE SUMMARY A 78-year-old man with a history of colorectal cancer developed epigastric pain and diarrhea after receiving combination chemotherapy of fluorouracil,leucovorin,irinotecan,and cetuximab.Abdomen radiography revealed in-tramural air in the small intestinal wall.A computed tomography scan of the abdomen revealed the features of PI with air expanding into the mesentery.After surgery,the patient remained symptom-free throughout a 9 mo follow-up period during which he received chemotherapy of fluorouracil,leucovorin,and irinotecan.CONCLUSION Although chemotherapy-induced PI is rare among patients with cancer,the differential diagnosis of PI and fulminant complications(such as ischemia,infarction,and perforation of the gastrointestinal tract)should be conducted,in which case an urgent surgical intervention is required.

Portal vein gas combined with pneumatosis intestinalis and emphysematous cystitis:A case report and literature review

BACKGROUND Portal venous gas(PVG)is a rare clinical condition usually indicative of severe disorders,including necrotizing enterocolitis,bowel ischemia,or bowel wall rupture/infarction.Pneumatosis intestinalis(PI)is a rare illness characterized by an infiltration of gas into the intestinal wall.Emphysematous cystitis(EC)is relatively rare and characterized by intramural and/or intraluminal bladder gas best depicted by cross-sectional imaging.Our study reports a rare case coexistence of PVG presenting with PI and EC.CASE SUMMARY An 86-year-old woman was admitted to the emergency room due to the progressive aggravation of pain because of abdominal fullness and distention,complicated with vomiting and stopping defecation for 4 d.The abdominal computed tomography(CT)plain scan indicated intestinal obstruction with ischemia changes,gas in the portal vein,left renal artery,superior mesenteric artery,superior mesenteric vein,some branch vessels,and bladder pneumatosis with air-fluid levels.Emergency surgery was conducted on the patient.Ischemic necrosis was found in the small intestine approximately 110 cm below the Treitz ligament and in the ileocecal junction and ascending colon canals.This included excision of the necrotic small intestine and right colon,fistulation of the proximal small intestine,and distal closure of the transverse colon.Subsequently,the patient displayed postoperative short bowel syndrome but had a good recovery.She received intravenous fluid infusion and enteral nutrition maintenance every other day after discharge from the community hospital.CONCLUSION Emergency surgery should be performed when CT shows signs of PVG with PI and EC along with a clinical situation strongly suggestive of bowel ischemia.

Inactivation of Giardia Intestinalis by Peroxone Process( H_2O_2/ O_3) and Its Disinfection Mechanisms

The efficency of peroxone( H2O2/ O3) to inactivate Giardia intestinali( G. intestinali) was investigated by the fluorescence staining method and vitro excystation. In order to investigate the mechanisms of inactivation,such as cell surface or inner cell components damage,they were comparatively examined by scanning electron microscopy( SEM),protein assay,and DNA gel analysis. When independent addition of O3 was under 1. 5mg·L- 1and contact time reached 10. 0 min,the inactivation rate achieved 99. 6%. At the same time,to achieve the same inactivation effect by H2O2/ O3,1. 0 mg·L- 1O3( [H2O2]/[O3] = 0. 8) with7. 0 min was required. Results suggest that hydroxyl radicals( ·OH) was the principal factor during the H2O2/ O3 process by testing the effect of t-butyl alcohol( TBA) and concentration change of H2O2. Although disinfectant potency of have its drawback of residual effect is transitory, but H2O2/ O3 could further strengthen the capability of inactivation, as well as reducing O3 dosage significantly. Meanwhile,SEMprotein assay,and DNA gel analysis indicate that H2O2/ O3 can destroy the cell surface,degrade the protein,and damage the genomic DNA of G. intestinali.

HIV-1感染者肠道产丁酸菌F.prausnitzii和R.intestinalis变化特点

目的初步探讨2种肠道产丁酸菌F.prausnitzii和R.intestinalis在HIV-1感染中的特点以及与疾病进展的关系。方法20例未治疗HIV-1感染者纳入研究对象(HIV-1感染组),以20例年龄、性别等相匹配的健康人作为对照。收集研究对象的血液及粪便标本。提取粪便细菌基因组DNA,应用实时荧光定量PCR方法对2种产丁酸菌进行定量分析,检测患者的临床指标,用SPSS 20.0软件进行统计学分析。结果对照组与HIV-1感染组中F.prausnitzii拷贝数(log)分别为(7.47±7.48)copies/μl、(7.46±7.42)copies/μl,R.intestinalis拷贝数(log)分别为(6.74±6.75)copies/μl、(6.45±6.44)copies/μl,2组之间差异均无统计学意义(P均>0.05)。2组粪便中F.prausnitzii水平均高于R.intestinalis。2种细菌的拷贝数呈正相关(对照组r=0.447,HIV-1感染组r=0.499)。HIV-1感染组F.prausnitzii的拷贝数与CD4+/CD8+T细胞比值呈正相关(r=0.573)。结论HIV-1感染后产丁酸的优势菌株F.prausnitzii与CD4+/CD8+T细胞比值呈正相关,该细菌可能与免疫状态相关。

Rare etiology of colonic intussusception involving an adult with emphysematous cystic enteropathy:A case report and review of literature

BACKGROUND Pneumatosis cystoides intestinalis(PCI),characterized by a collection of gas-filled cysts in the intestinal wall,is an uncommon but well-known condition in gastroenterology.Abdominal pain is the most frequent symptom associated with PCI.Intussusception represents a potential cause of recurrent abdominal pain or emergency presentation.However,the occurrence of colonic intussusception secondary to PCI is very unusual in adulthood.CASE SUMMARY A 52-year-old male,known with idiopathic PCI,presented seventeen months after initial diagnosis with a new right upper quadrant pain.A computed tomographyscan demonstrated a colonic intussusception at the hepatic flexure.PCI did not progress compared with initial investigation.The patient underwent an emergency right hemicolectomy.CONCLUSION Resection was recommended in this case because PCI proved to be persisting with no identified curable cause.Surgery allowed to address the underlying pathology,the potential relapse of intussusception,and the likely cause of recurrent abdominal pain,either invagination or PCI itself.

Antimicrobial and antioxidant activities of Cystoseira crinita Duby and Ulva intestinalis Linnaeus from the coastal region of Sinop,Turkey

Objective:To evaluate in vitro antimicrobial,antioxidant activities and total phenol contents of Cystoseira crinita and Ulva intestinalis species collected from the coastal region of Sinop.Methods:The antimicrobial activity of each methanolic algae sample was screened by using disc diffusion method against to 15 bacteria and 3 yeasts.The antioxidant potential of the extracts on the stable radical 1,1-diphenyl-2-picrylhydrazyl was determined.The total phenolic content of the 3 methanolic extracts of the seaweed samples were determined by the Folin-Ciocalteu method.Results:The results of antimicrobial assay showed that extracts were more effective against Gram-positive bacteria rather than Gram-negative.In addition,while the algal extracts had antifungal efficacy against Candida krusei,the other yeast strains were not affected at all.According to the findings of antioxidant activity,all methanolic extracts displayed good free radical scavenging activity ranging from IC_(50)=(32.19±0.08)mg/mL to the IC_(50)=(37.57±0.11)mg/mL.The total phenols content of the macroalgal extracts were found as between(5.10±0.16)mg gallic acid equivalent/g and(87.70±1.03)mg gallic acid equivalent/g.In this sense,our findings confirmed that there was a positive linear correlations(r=0.86)between total phenol contents and the IC_(50) values.Conclusions:The data gathered from this study suggested that the seaweeds can be used as a potential natural seafood sources owing to the antimicrobial efficiency and good antioxidant activity.

玻璃海鞘多肽的分离纯化及其抗血管生成活性

利用丙酮沉淀，SephadexG25柱层析、Superdex75快速蛋白纯化系统（FPLC）等分离手段，采用活性追踪的方法，从玻璃海鞘（Coina intestinalis）中分离纯化出抗血管生成多肽PCI，据保留时间计算其分子质量为1．8ku。PCI在50～90℃范围内有良好的热稳定性，多肽水解酶处理可引起活性丧失。四甲基偶氮唑盐比色（MTT）检测表明其对人脐静脉血管内皮细胞（HUVEC）具有强烈的抑制作用，IC50为7．5mg／L。在斑马鱼（Danio rerio）胚胎体内实验中进一步表明，PCI在40mg／L的浓度下作用12h，斑马鱼胚胎新生血管生成受到显著抑制，肠下静脉血管长度为正常组的30％，斑马鱼胚胎血管生成率为正常组的45％。

Influence of bioactive sulphated polysaccharide-protein complexes on hepatocarcinogenesis, angiogenesis and immunomodulatory activities

Objective:To explore the in vivo anticancer,anti-angiogenesis and immunomodulatory efficacies of the bioactive polysaccharide isolated from cold aqueous extract of Jania rubens(JCEM) and Pterocladia capillacea(PCEM) as well as hot aqueous extract of Enteromorpha intestinalis(EHEM) against hepatocellular carcinoma rat model(HCC) and to study their chemical composition.Methods:The sugars and amino acids composition of the bioactive polysaccharides of JCEM,PCEM and EHEM were determined using gas liquid chromatography and amino acid analyzer,respectively.These polysaccharide extracts(20 mg/kg b.wt.for 5 weeks) were assessed on hepatocarcinogenesis in rats and α-fetoprotein(AFP),carcinoembryonic antigen(CEA),glypican-3(GPC-3),hepatocyte growth factor(HGF) and vascular endothelial growth factor(VEGF) and Ig G levels were evaluated.Results:The GLC analysis of JCEM,PCEM and EHEM polysaccharide revealed the presence of 10,9 and10 sugars,in addition the amino acid analyser enable identification of 16,15 and 15 amino acids,respectively.These polysaccharide extracts of JCEM,PCEM and EHEM produced significant decrease in serum AFP,CEA,GPC-3,HGF and VEGF compared with untreated HCC group.JCEM,PCEM and EHEM had an immunostimulatory responses by increasing the IgG levels as compared by naive value(1.23,1.53 and 1.17 folds),respectively.The bioactive polysaccharides in HCC induced rats improved the humoral immune response.The photomicrographs of liver tissue sections of the groups of HCC treated with polysaccharide extracts of Jania rubens and Enteromorpha intestinalis showed intact histological structure.Moreover,fractions HE1,HE4,HE7 obtained from polysaccharide of EHEM showed moderate cytotoxic activity against Hep G2 in vitro with IC_(50) 73.1,42.6,76.2 μg/mL.However,fractions of PCEM and JCEM show no or weak cytotoxicity against Hep G2 in vitro where the cytotoxic activity of their crude polysaccharide extract proved synergetic effect.Conclusions:The pronounced antitumor activity of sulphated polysaccharide-protein complexes of JCEM and EHEM is due to direct cytotoxic activity,anti-hepatocarcinogensis,and anti-angiogenesis.In addition,JCEM,PCEM and EHEM had an immunostimulatory response and improved the humoral immune response in HCC induced rats.