Indian Journal of Pathology and Microbiology
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Year : 2020  |  Volume : 63  |  Issue : 2  |  Page : 325-326
Bubbly bowel: A life-threatening condition

Department of Pathology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra, India

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Date of Web Publication18-Apr-2020

How to cite this article:
Shetty DS, Naik LP, Amarapurkar AD. Bubbly bowel: A life-threatening condition. Indian J Pathol Microbiol 2020;63:325-6

How to cite this URL:
Shetty DS, Naik LP, Amarapurkar AD. Bubbly bowel: A life-threatening condition. Indian J Pathol Microbiol [serial online] 2020 [cited 2021 Nov 27];63:325-6. Available from: https://www.ijpmonline.org/text.asp?2020/63/2/325/282695

An 85-year-old female with uncontrolled diabetes presented to the hospital with the complaints of pain, ulcer, and foul smelling discharge from both feet. She was on oral hypoglycemics. The patient was conscious, oriented, afebrile, and her vitals were stable. Hematological examination revealed a total WBC count of 20,500/mm3 (neutrophils - 86%). Wound swab culture revealed growth of Escherichia coli and Klebsiella pneumoniae. Ultrasonography of both the lower limbs showed atherocalcific changes. Bilateral below knee amputation was done in view of diabetic foot ulcers.

Three days after the surgery, patient complained of abdominal distension, severe pain in abdomen, and constipation. She was oriented, afebrile with tachypnea and tachycardia. Ultrasonography was suggestive of intestinal obstruction. Computed tomography of abdomen and pelvis was also suggestive of intestinal obstruction and showed multiple air foci in bowel wall, superior mesenteric vein, and portal vein [Figure 1]. An emergency exploratory laparotomy was done and gangrenous small bowel loops were sent for histopathological examination. Patient died 2 days after the surgery.
Figure 1: Computed tomography of abdomen and pelvis showing air within bowel wall (arrow)

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Segment of small intestine was sent for histopathological examination measuring 400 cm in length. Serosal surface appeared dusky with thinning of wall. The mucosal folds appeared flattened. Focal areas of the bowel wall had a spongy consistency. The resection margins appeared viable. Microscopic examination revealed features of acute ischemic enteritis. The submucosa showed multiple empty dilated cystic spaces without any lining epithelium [Figure 2]a. Immunohistochemistry for vascular endothelial marker CD34 [Figure 2]b and PAS stain was positive in the surrounding blood vessels but negative in the submucosal cystic spaces. Thus, lymphangiectasia was ruled out. PAS stain also helped us to rule out fungal etiology. There was no evidence of vasculitis. A diagnosis of acute ischemic enteritis with intestinal pneumatosis was suggested.
Figure 2: (a) Photomicrograph showing submucosa with multiple empty dilated cystic spaces without any lining epithelium (arrow) (hematoxylin and eosin, 40×). (b) Photomicrograph showing positive CD34 stain in the surrounding vessels (black arrow) but negative in the submucosal cystic spaces (red arrow) (CD 34, 100×)

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Intestinal pneumatosis is a rare and life-threatening condition. It is characterized by the presence of multiple gas filled cystic spaces within the bowel wall.[1] The overall incidence was reported as 0.03%.[2] Majority of the cases (85%) are secondary to chronic obstructive pulmonary disease, trauma, sigmoid volvulus, collagen vascular diseases, adult ischemic bowel disease, and infectious colitis. Only 15% cases are primary (idiopathic).[3] Our case is pneumatosis cystoides intestinalis secondary to sepsis in a patient who underwent bilateral below knee amputation. The diagnosis is possible only on radiological and pathological findings.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Gui X, Zhou Y, Eidus L, Falck V, Gao Z, Qin L. Is pneumatosis cystoides intestinalis gas-distended and ruptured lymphatics? Reappraisal by immunohistochemistry. Arch Pathol Lab Med 2014;138:1059-66.  Back to cited text no. 1
Khalil PN, Huber-Wagner S, Ladurner R, Kleespies A, Siebeck M, Mutschler W, et al. Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res 2009;14:231-9.  Back to cited text no. 2
Blair HA, Baker R, Albazaz R. Pneumatosis intestinalis an increasingly common radiological finding, benign or life-threatening? A case series. BMJ Case Rep 2015;2015. pii: bcr2014207234. doi: 10.1136/bcr-2014-207234.  Back to cited text no. 3

Correspondence Address:
Anjali D Amarapurkar
Department of Pathology, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_474_19

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