Pneumatoris coli is a special form of pneumatosis intestinalis characterized by gas accumulation in the wall of the colon. The phenomenon is often accompanied by cyst formation. Treatment depends on the primary cause and can range from antibiotic administration to therapeutic endoscopy.
What is pneumatoris coli?
Pneumatosis intestinalis is present when there is an intramural accumulation of gas in the digestive tract. In medicine and radiology, this phenomenon is a highly rare finding that predominantly affects the colon. In this case, the gas accumulation is located in the wall of the colon or wider digestive tract and can occur in different layers of the organs. The subserosal form below the serosa is differentiated from a submucosal form below the mucosa. Pneumatosis intestinalis can also be classified according to the organ involved. An intramural gas accumulation in the colon is called pneumatosis coli in this context. In pneumatosis cystoides coli, the gases are present in the colon wall in the form of cystic inclusions. The first use of the term pneumatosis intestinalis was by Lerner and Gazin and dates to 1946. The exact cause of the disease has not yet been conclusively determined. Because the disease is extremely rare and thus only a few case reports exist, research into the cause is likely to take some time.
Causes
Pneumatosis coli can present as either a primary idiopathic or secondary case. Secondary occurrence in the setting of another general illness corresponds to the more common variant. Infections are a possible cause. For example, an infection caused by the colonized bacteria may result in the increased formation of gases. The formation of gas-containing cysts is conceivable in this context. Mechanical factors are also conceivable. In some secondary cases, pneumatosis coli has also been associated with obstructive lung diseases, such as bronchial asthma or chronic obstructive pulmonary emphysema. Intestinal necrosis due to ischemia, necrotizing enterocolitis, sepsis, and intraluminal increased pressure due to gastric ulcers are currently under discussion as causes. In addition, an association with immunosuppressed patients has been observed. Immunosuppression is speculated to be associated with decreased intestinal wall integrity, so that gas entry may occur secondarily.
Symptoms, complaints, and signs
Pneumatosis coli can present with a number of different symptoms and complaints. Typically, the disease is associated with acute and violent diarrhea. Diarrhea occurs at the onset of the disease and becomes more severe as it progresses. This is accompanied by stomach pain, flatulence and occasionally bloody excretions. In individual cases, deficiency symptoms may occur as a result of the high fluid loss. In the course of the disease, other complaints are added, especially in the area of the gastrointestinal tract. This considerably reduces the quality of life of those affected. As a consequence, psychological complaints such as depression or [[anxiety|anxiety]] often develop. Inferiority complexes and reduced self-esteem are also typical. On the physical side, pneumatosis coli can develop into Chron’s disease. Chronic gastrointestinal complaints then occur, such as flatulence and a bloated abdomen, which represent a further health burden for the affected person. If the disease is treated early, such a severe course can normally be averted. The symptoms of pneumatosis coli subside after a few days, provided that the underlying condition is carefully cured. In the absence of treatment, chronic symptoms develop, which severely limit the quality of life and life expectancy of the sufferer.
Course
The clinical picture of patients with pneumatoris coli depends on the individual case and, especially in the secondary form, is shaped by the primary cause. For example, pain is as conceivable as impaired digestion or bowel motility. Common to all patients is the accumulation of gas in the intestinal wall. In most patients, this accumulation is inform of cysts and usually affects the area of the right colon. Less commonly, the left or transverse colon is affected.In the later course, more or less severe complications may occur in the intestine. Obstructions of the colon are in the foreground. However, gastrointestinal bleeding is also conceivable. In extreme cases, perforation of the intestine has been observed. In medicine, this is defined as a puncture or perforation of the tissue that surrounds the intestine. In addition, immunologic inflammation of the colon is conceivable as part of complications.
Diagnosis and course of the disease
The most important criteria for a diagnosis of pneumatoris coli are the gases in the intestinal wall or, if applicable, the gas-filled cysts. The physician detects the gas collections by abdominal radiography. Differentially, pseudopolyps should be excluded in the case of cysts. The distinction can be made by gas analysis. In most cases, cysts contain gas in a composition of five to fifteen percent O2, up to ninety percent N2, and between 0.3 and five percent CO2. False positive findings may result from flatulence. Computed tomography is considered the method of choice for reliable differentiation, as this imaging can be used to distinguish between intramural and extramural gas accumulation. Except for the complications mentioned above, the course of pneumatoris coli is considered benign.
Complications
In this disease, affected individuals primarily suffer from various digestive disorders. These usually have a very negative effect on the quality of life of the affected person and can significantly reduce it. Deformities of the intestine can also occur as a result of the disease and significantly reduce the patient’s quality of life. Inflammation and thus various complications occur. Gases can accumulate in the intestinal wall, resulting in the formation of cysts. If the disease is not treated, life expectancy may be significantly reduced. Ulcers in the stomach can also occur and have an equally negative effect on digestion. In many cases, those affected then deliberately eat less food and suffer from underweight or various deficiency symptoms. In most cases, no complications occur during treatment. With the help of surgical procedures, the cysts can be well removed. Likewise, patients depend on taking antibiotics to avoid inflammation. Whether there is a decreased life expectancy due to pneumatosis coli cannot be universally predicted.
When should you see a doctor?
When gastrointestinal symptoms and other signs of pneumatosis intestinalis or pneumatosis coli occur, a visit to the doctor is always recommended. The medical professional can diagnose the rare intestinal disease and suggest further action. Anyone who notices signs of intestinal obstruction or even intestinal rupture must call the emergency physician. The symptoms must be clarified immediately and, if necessary, treated with intensive care. Affected persons can call in their family doctor or gastroenterologist. Other contacts are the internist or a pulmonary specialist. If psychological problems have arisen as a result of the gastrointestinal problems, a therapist can also be consulted. People who have recently suffered a gastrointestinal infection or have intestinal cysts are particularly at risk. Obstructive lung disease is also associated with pneumatosis coli. Those who are at risk should consult with their physician if they experience any of the above symptoms. Further medical evaluation is necessary if, after recovery, gastrointestinal symptoms or other symptoms suddenly reappear, indicating that the disease has returned or has not been fully cured.
Treatment and therapy
Therapy for secondary pneumatoris coli is based primarily on the primary disease. Primary pneumatoris coli does not necessarily require therapy, but may be followed up under certain circumstances. This is especially true for cases with low gas accumulation that do not cause symptoms. If cystic inclusions are present, the cysts are ideally removed by minimally invasive procedures. One such procedure available is therapeutic endoscopy, which is commonly used for bowel procedures such as polyp removal. The body envelope is spared in the process.Under certain circumstances, treatment with antibiotics may be required in addition to removal of the cysts and in the case of cyst-free gas deposits. This treatment is preferably based on the administration of metronidazole. Only in extremely severe cases, pneumatoris coli requires the administration of oxygen for several days. If complications occur, the treating physician should act as quickly as possible to prevent perforation of the intestine. In this context, surgical intervention may be the treatment of choice. Minor bleeding, on the other hand, does not necessarily require surgical intervention and must be discussed by the physician in light of the benefits and risks.
Prevention
To date, there are no known causes of pneumatoris coli except for its association with certain primary diseases. This limits preventive measures to the primary causes mentioned in each case. No preventive steps are yet available for ideopathic pneumatoris coli.
Follow-up
Very few or even very limited measures of follow-up are available to the affected person in most cases of pneumatosis coli. Because it is a very rare disease, it is usually detected only by chance. Therefore, the most important thing in this disease is a quick and, above all, an early diagnosis, so that there are no complications or other complaints in the further course of the affected person. Pneumatosis coli usually does not heal itself, so that the affected person is always dependent on medical treatment. Most patients require surgical intervention to alleviate the symptoms. After such an operation, the affected person should in any case rest and take care of his body. Efforts or stressful and physical activities should be refrained from in any case. Likewise, only light food should be taken immediately after the procedure. Thereby, it cannot be generally predicted whether pneumatosis coli will reduce the life expectancy of the affected person.
Here’s what you can do yourself
Since this very rare condition is a form of pneumatosis intestinalis, the same recommendations for self-help in everyday life apply here. First of all, however, it is also true here that there may be another underlying condition that has caused the pneumatosis coli. It should be found and treated. Because the disease is often associated with lung disease, patients should definitely stop smoking. Exercise and sports training in the fresh air supports lung function. If bronchial asthma or even emphysema is already present, these conditions must be treated according to guidelines. In the case of pneumatosis coli, it is important to support the body’s own immune system, because the immune defenses of affected patients are often weakened. If the diarrhea is severe, it can be helpful if the affected person follows an appropriate diet. It is also essential to compensate for the loss of fluids. Up to three liters of fluid intake per day are necessary for this purpose. Drinks such as non-carbonated water, mild herbal teas or vegetable broths are recommended. A regulated sleep-wake rhythm with sufficient hours of rest also supports the immune system. Taking live intestinal bacteria supports the intestinal flora.
