Abstract
Pneumatosis intestinalis and gas within the portal venous system are findings predictive of bowel ischemia. The etiologies of these alarming radiographic signs are diverse and not all causes require emergent surgical intervention. The combination of pneumatosis intestinalis, portal venous gas, and acidosis typically portends bowel ischemia and inevitable necrosis. This case report is the first description of benign pneumatosis and portal venous gas secondary to irinotecan and cisplatin.
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Schulze CG, Blum U, Haag K (1995) Hepatic portal venous gas: imaging modalities and clinical significance. Acta Radiol 36:377–380
Kernagis LY, Levine MS, Jacobs JE (2003) Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel. AJR Am J Roentgenol 180:733–736
Rha SE, Ha HK, Lee SH, Kim JH, Kim JK, Kim JH, Kim PN, Lee MG, Auh YH (2000) CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics 20:29–42
Galm O, Fabry U, Adam G, Osieka R (2001) Pneumatosis intestinalis following cytotoxic or immunosuppressive treatment. Digestion 64:128–132
Peloponissios N, Halkic N, Pugnale M, Jornod P, Nordback P, Meyer A, Gillet M (2003) Hepatic portal gas in adults. Arch Surg 138:1367–1370
Knechtle SJ, Davidoff AM, Rice RP (1990) Pneumatosis intestinalis: surgical management and clinical outcome. Ann Surg 212:160–165
Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB (1978) Hepatic-portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg 187:281–287
Griffiths DM, Gough MH (1986) Gas in the hepatic portal veins. Br J Surg. 73:172–176
Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol. 177:1319–1323
Alimonti A, Gelibter A, Pavese I, Satta F, Cognetti F, Ferretti G, Rasio D, Vecchione A, Di Palma M (2004) New approaches to prevent intestinal toxicity of irinotecan-based regimens. Cancer Treat Rev 30:555–562
Rothenberg M (2001) Irenotecan (CPT-11): recent developments and future directions–colorectal cancer and beyond. Oncologist 6:66–80
Van Huyen JPD, Bloch F, Attar A, Levoir D, Kreft C, Molina T, Bruneval P (1998) Duffuse mucosal damage in the large intestine associated with irinotecan. Dig Dis Sci 43:2649–2651
Araki E, Ishikawa M, Iigo M, Koide T, Itabashi M, Hoshi A (1993) Relationship between development of diarrhea and the concentration of SN-38, an active metabolite of CPT-11, in the intestine and the blood plasma of athymic mice following intraperitoneal administration of CPT-11. Jpn J Cancer Res 84:697–702
Sandmeier D, Chaubert P, Bouzourene H (2005) Irinotecan-induced colitis. Int J Surg Pathol 13:215–218
Fuertes MA, Castilla J, Alonso C, Pérez JM (2003) Cisplatin biochemical mechanism of action: from cytotoxicity to induction of cell death through interconnections between apoptotic and necrotic pathways. Curr Med Chem 10:257–266
Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A, Fukuoka M, Mori K, Watanabe K, Tamura T, Yamamoto S, Saijo N (2002) Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. New Engl J Med 346:85–91
Tan HL, Tantoco JG, Ee MZ (2007) The role of diagnostic laparoscopy in micropremmies with suspected necrotizing enterocolitis. Surg Endosc 21:485–487
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Kung, D., Ruan, D.T., Chan, R.K. et al. Pneumatosis Intestinalis and Portal Venous Gas Without Bowel Ischemia in a Patient Treated with Irinotecan and Cisplatin. Dig Dis Sci 53, 217–219 (2008). https://doi.org/10.1007/s10620-007-9846-9
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DOI: https://doi.org/10.1007/s10620-007-9846-9