Pneumatosis is a pathological condition of the digestive system (the walls of the intestine or stomach are more often involved), in which cavities (cysts) are formed in the wall that are filled with air or gases.
As pneumatosis progresses, it can move to the area of the mesentery, lymph nodes or into the peritoneum.
Pneumatosis often occurs in young children after intestinal infections, which is found during surgeries for intestinal obstruction.
The basis of intestinal pneumatosis is a pathological accumulation of gases, which are usually formed in the intestine, in its mucous membranes. Gases accumulate, forming air cavities and cysts, instead of being absorbed into the bloodstream and excreted.
The main reasons for the formation of pneumatosis include:
- the early age of children with their low mobility,
- violation of peristaltic bowel movements,
- increased abdominal pressure, bowel spasms,
- signs of intestinal obstruction,
- violation of the discharge of gases through the anus,
- severe intestinal infections with lesions of the small and large intestine, as a result of which gas, as a metabolic product of microbes, accumulates in the damaged intestinal walls (E. coli, proteus).
An additional factor in the development of intestinal pneumatosis is air penetration from the stomach with its penetration into the intestinal wall. A violation of the development of lymphatic capillaries in the intestinal wall is also of some importance.
Intestinal pneumosis may be limited or spread to the small intestine or the entire intestine.
Most often there is pneumatosis of the ileal part of the intestine and the ileocecal zone. In this case, the intestine may resemble in appearance bunches of grapes or soap foam, in rare cases, air cysts occur singly.
There are no typical and typical complaints for pneumatosis, all complaints are due to the processes that occur in the abdominal cavity.
Cystic pneumatosis or simply pneumatosis of the intestines is a rare disease and there are few observations on it to accurately describe the clinical picture of the disease.
The severity and severity of intestinal and extraintestinal manifestations depend on the length and progression of the process.
First of all, the main complaints of intestinal pneumatosis are manifestations flatulence , in the intestine is formed an excessive amount of gases, which strongly stretch the intestinal wall, causing severe discomfort in the abdomen, a feeling of distention, pressure, soreness.
The passage of peristaltic bowel waves may be accompanied by cramping or colicky pains , there may often be problems with the stool, and these may be diarrhea ( diarrhea, loose stools) or constipation, lasting up to several days.
Severe pneumatic bowel can lead to intestinal obstruction due to the closure of the intestinal lumen swollen air cysts. Often, the pressure of the gas inside the intestine increases too much, as a result, gas cysts break, with the penetration of the intestinal contents and gases into the abdominal cavity with symptoms peritonitis.
Also signs of pneumatosis can be heaviness in the abdomen, belching with air, a feeling of overflowing of the intestine with air, discharge of gas, pain in the abdomen along the intestine, relief of pain after stool, nausea, and even vomiting.
With the development of peritonitis, the state is sharply disturbed, there is pallor, abdominal pain and “dumb abdomen” with no signs of peristalsis, a decrease in pressure, a shock.
The basis of the diagnosis is complaints by the patient that are so non-specific that they can occur in almost any bowel disease of both infectious and non-infectious genesis.
Inspection data may show signs of bloating and rumbling in the abdomen, a feeling of gas rolling under the arms in the gut.
An experienced surgeon can detect air cysts in the wall of the intestine when probing the intestinal wall, if their size is large enough. Cysts are arranged in groups, chains, similar to a bunch of grapes.
Confirm the diagnosis can only methods of endoscopy – with them visually visible gas bubbles along the intestine.
X-ray diagnostic methods can also be used with or without contrast.
Usually pneumatoz is considered as a secondary process, therefore, the therapy of those diseases and conditions that caused the defeat of the intestinal wall is mainly carried out.
First of all, it is the treatment of intestinal infections in young children with intestinal antiseptics and rational antibiotics according to the results of seeding.
With the development of intestinal obstruction, an urgent operation is needed, with constipation – the normalization of nutrition and the intake of laxatives, with the spasmodic processes of the intestine – the reception of antispasmodics.
In pneumatosis, symptomatic treatment is also indicated:
- carminative drugs (against the formation of gases),
- antispasmodic drugs (baralgin no-shpa),
- antidiarrheal drugs (tsirukal, motilium),
- laxative drugs series.
If symptoms of peritonitis appear, immediate surgery and drainage of the abdominal cavity are necessary.
The main and most dangerous complication of pneumatosis may be intestinal obstruction with necrosis of part of the intestine and the development of peritonitis.
The prognosis for life is favorable with the timely start of treatment.