Cystic intestinal pneumatosis revealed by peritonitis in perforated peptic ulcer: A case report

摘要

Kistik ba??rsak pneumatosisis sindirim sistemi duvarlar?nda kist benzeri olu?umlar?n varl??? ile karakterize nadir bir durumdur. Kistik ba??rsak pn?motozu sindirim sisteminin herhangi bir b?lümünü etkileyebilir. Bununla birlikte, kü?ük ve büyük ba??rsaklar en ?ok etkilenenlerdir. Bu patoloji erkeklerde ve 50 ya??ndan sonra daha yayg?nd?r. Ba??rsaklar?n kistik pn?matozu, idiopatik veya ?o?u zaman ?e?itli hastal?klara ikincil olabilir. ?lkel formlar, esas olarak submukozlu gazl? kistler ile sol kolonunu tercih ederler, oysa sekonder intestinal kistik pn?matozlar, ?zellikle ince ba??rsaklar?n subserozas?n? etkileme e?ilimindedir. Bu patolojinin k?keni ?ok fakt?rlüdür, ancak ana sebep kesin olarak kan?tlanmam??t?r. Patolojik ili?kilerin uzun listesi, ?e?itli etiyopatojenik teorilerin geli?mesine yol a?m??t?r. Kistik ba??rsak pn?motozu en s?k asemptomatiktir ve bu nedenle tesadüfi bir ?ekilde saptan?r. Bu patoloji kanl? d??k?lama, kar?n a?r?s? ve diyare gibi klinik belirtilere sahip olabilir. Endoskopik ve radyolojik incelemeler benign pn?moperitoneumda gereksiz laparotomi eksplorasyonlar?n? tespit etmek ve ?nlemek i?in faydal?d?r. Tedavi etiyolojisine g?re de?i?ir. Birincil formlar i?in, hidrojen üreten kolonik floray? azaltmak i?in antibiyotik tedavisi, birinci basamak tedavi olarak belirtilmektedir. Ba?ar?s?z ise, oksijen ile oksijen de?i?tirilmesini te?vik edecek oksijen maskesi veya hiperbarik tedavi denenmelidir. Sekonder formlar i?in tedavi, nedensel olarak de?i?kendir. ?o?u durumda, kistik ba??rsak pn?matozu asemptomatiktir ve tedaviye gerek yoktur. Cerrahi, bu hastal???n ciddi formlar? i?in ayr?lm??t?r. Cystic intestinal pneumatosis is a rare condition characterized by the presence of cyst-like formations in the walls of the digestive tract. Cystic intestinal pneumatosis can affect any part of the digestive tract. However, the small and large bowels are the most affected. This pathology is more common in men and after the age of 50 years. Cystic pneumatosis of the intestines may be idiopathic or most often secondary to various diseases. The primitive forms preferentially affect the left colon with essentially submucous gaseous cysts, whereas the secondary intestinal cystic pneumatosis tend to affect the small intestines especially in the subserosa. The origin of this pathology is multifactorial but the main cause is not definitively proven. The long list of pathological associations has led to the development of various etiopathogenic theories that are not antinomic since some mechanisms may be associated. Cystic intestinal pneumatosis is most often asymptomatic and therefore fortuitously discovered. This pathology could have clinical signs like bloody and glairy stools, abdominal pain, and diarrhea. Endoscopic and radiological examinations are easy to diagnose and avoid unnecessary laparotomy explorations in benign pneumoperitoneum. Treatment varies according to its etiology. For primary forms, antibiotic therapy to reduce the hydrogen-producing colonic flora is indicated as first-line treatment. If unsuccessful, oxygen mask or hyperbaric, which will promote the replacement of hydrogen with oxygen, must be attempted. For secondary forms, the treatment is that of the causal affection. In most cases, cystic intestinal pneumatosis is asymptomatic and no treatment is needed. Surgery remains reserved for serious forms of this disease.