title: Pneumatosis cystoides intestinalis in scleroderma-related conditions.
abstract: OBJECTIVE
  Pneumatosis cystoides intestinalis (PCI) is a rare life-threatening gastrointestinal complication in the course of connective tissue disease (CTD). PCI is characterised by the appearance of intramural clusters of gas in the small and large bowel wall on X-ray or computed tomography and often is accompanied by free air in the peritoneal cavity.
  
  
  METHODS
  We present three cases of PCI in patients with scleroderma-related conditions. A review of the English language literature published on MEDLINE from 1973 to 2008 was conducted using the terms: 'systemic sclerosis', 'connective tissue disease' and 'pneumatosis cystoides intestinalis'. This review focused on clinical features, diagnostic and treatment strategies of PCI in the context of CTD.
  
  
  RESULTS
  Symptoms of PCI are non-specific: abdominal pain, vomiting, constipation, bloating and weight loss. Coexistence of PCI with other manifestations of CTD, such as intestinal pseudo-obstruction and/or bacterial overgrowth, complicates the clinical diagnosis. Treatment approach to PCI is mostly conservative: intestinal 'rest', parenteral nutrition, antibiotics, fluids and electrolyte supplementation, and inhaled oxygen. Surgical intervention should be performed only in cases of bowel perforation, ischaemia or necrosis. Patients with PCI have high mortality rates due to PCI itself but also to the severity and variety of basic CTD complications.
  
  
  CONCLUSIONS
  Recognition of PCI, particularly in the context of underlying CTD, is necessary for proper therapeutic application. In patients with underlying CTD and symptoms of abdominal emergency, recruitment of multidisciplinary teams, including rheumatologist, gastroenterologist, imaging specialist and surgeons familiar with intestinal complications of CTD-related conditions, is warranted.
authors.affiliation: B. Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel. a_balbir@rambam.health.gov.il
authors.forename: A
authors.initials: A
authors.lastname: Balbir-Gurman
authors.forename: O R
authors.initials: OR
authors.lastname: Brook
authors.forename: I
authors.initials: I
authors.lastname: Chermesh
authors.forename: Y
authors.initials: Y
authors.lastname: Braun-Moscovici
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003240:Connective Tissue Diseases / Q000150:complications; D003937:Diagnosis, Differential; D003974:Diatrizoate Meglumine / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007415:Intestinal Obstruction / Q000175:diagnosis; D007418:Intestinal Pseudo-Obstruction / Q000209:etiology; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D011006:Pneumatosis Cystoides Intestinalis / Q000175:diagnosis / Q000209:etiology*; D011027:Pneumoperitoneum / Q000209:etiology; D017285:Polymyositis / Q000150:complications; D012595:Scleroderma, Systemic / Q000150:complications* / Q000628:therapy; D012859:Sjogren's Syndrome / Q000150:complications / Q000175:diagnosis; D015431:Weight Loss
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D003974:Diatrizoate Meglumine; D009853:Omeprazole; D015282:Octreotide