These pictures show two sides of a specimen of the ascending colon dissected at autopsy (A: mucosal side; B: serous side). The macroscopic appearance of the specimen shows diffuse hemorrhage on both serous and mucosal sides, but a lack of any necrotic feature, consistent with a finding of intraluminal bleeding. Discussion PI is an uncommon condition characterized by the presence of multiple cystic or linear gas deposits within the intestinal wall. In adult patients, PI is frequently asymptomatic and detected only incidentally. DuVernoi first described the condition in 1783. Despite increasing recognition of PI with more prevalent use of CT
and colonoscopy, the pathogenesis remains poorly understood, even though the majority of the literature on PI has placed an emphasis on explaining its etiology. PI is frequently asymptomatic in adults and does not require Selleck PD0332991 specific therapy unless abdominal pain, emesis, fever, diarrhea or hematochezia is present. Pneumoperitoneum and pneumoretroperitoneum can be present, but are generally considered as complications rather than causes of PI . Peritonitis may occur, but is uncommon, and perforation is Selleckchem LDC000067 typically absent when only mild clinical symptoms are present . Most reported cases of adult PI detail a benign course in response to conservative
management buy CBL0137 with hyperbaric oxygenation or metronidazole. Death may occur in rare cases, typically associated with severe comorbid conditions (e.g., cancer, immunosuppressed status due to chemotherapy, diabetes mellitus, or portal venous air embolism) [2–5], or acute
abdomen followed by bowel ischemia, bowel obstruction, and portal venous gas (PVG) . The cause of Sulfite dehydrogenase death described in fatal PI cases ranges from sepsis to concomitant malignancies, as well as air embolus in the portal vein or colon perforation [2, 5, 7, 8]. To the best of our knowledge, no previous reports have described life-threatening hemorrhage simply due to PI in adults in either the perioperative or non-perioperative period. Surgical management of PI, usually consisting of urgent laparotomy in patients with acute abdomen, remains controversial. While surgery is probably necessary in severe cases, routine utilization of surgical management may be associated with poor prognosis. This determination is complicated by the fact that most studies of PI have described etiology or radiographic findings, but few have addressed clinical management, particularly from a surgical perspective [9–11]. Knechtle evaluated 27 patients with PI and reported the highest mortality rate among PI patients with bowel ischemia who underwent surgery, demonstrating associations of low pH (<7.3), low serum bicarbonate (<20 mmol/L) and elevated serum lactic acid (LA) (>2 mmol/L) with ischemic bowel and mortality . Hawn et al. assessed 86 patients showing PI on CT and reported a mortality rate of 73% among patients with complicated ischemic bowel and 83% in patients with hepatic failure .