Pneumatosis cystoides intestinalis--a report of two cases.

Pneumatosis cystoides intestinalis (PCI) has not been dif fer en ti ated as a sep a rate med i cal en tity, but con sid ered rather as a mor pho log i cal con di tion of an un known or i gin. The con di tion was for first re ported as a post-mor tem ob ser va tion by Du Vernoi in the eigh teenth cen tury. Al though this con di tion is usu ally asym p tom atic and in ci den tally found dur ing laparotomy or on ra dio log i cal in ves ti ga tion of un re lated symp toms, it can also cause ab dom i nal pain, sub acute in tes ti nal ob struc tion, intu ssusception, or rec tal bleed ing. It is char ac ter ized mainly by the pres ence of mid-mem brane cystoid air-filled cav i ties found usu ally in sub mu cosa or subserosa of the bowel [8, 25]. How ever, it must be high lighted that all parts of gas tro in tes ti nal tract may be in volved [7, 19] Typ i cally, PCI has been ob served to ac com pany the fol low ing clin i cal en ti ties: 1) in fant necrotizing entero co litis [20, 27], 2) chronic ob struc tive pul mo nary dis ease [13], 3) con nec tive tis sue dis eases (colla genoses) [3, 12, 14, 24, 26], 4) chronic gas tric ul cer with py loric ste no sis [6, 13]; a sig nif i cant rate of PCI was noted as a compli cation of liver, heart or bone mar row trans plan ta tion (in these cases it is thought to be linked to the immuno suppressive cytostatic or long-term ste roid treat ments) [1, 5, 17, 21, 23]. Other re ported cases were found to co-ex ist with Lesniowski-Crohn dis ease, ul cer ative co li tis, ce liac dis ease and var i ous can cers [8, 9, 22]. Lit er a ture data re port few cases of PCI re lated to var i ous ther a peu tic and di ag nos tic pro ce dures e.g. in tes ti nal anas to mo ses, en do scopic in ter ven tions within bowel (polypectomy), dou ble-con trast X-ray bowel ex am i na tion and jejunomicrostomy nu tri tion. PCI has been also de scribed to de velop in the course of HIV in fec tions and ischemic bowel dis ease or even in co caine ad dic tion [4].