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May 2, 1977

Gas in the Gut Wall

JAMA. 1977;237(18):1965-1966. doi:10.1001/jama.1977.03270450055025

For reasons largely unknown, clusters of gas-filled blebs occasionally collect in the intestinal wall. Called pneumatosis cystoides intestinalis (PCI), the ordinarily benign condition has been encountered in a wide variety of disorders affecting the gastrointestinal tract from stomach to rectum.1 Symptoms of PCI are mostly nonspecific: complaints such as diarrhea, constipation, melena, or flatulence predominating.

A clue to the causative mechanism derives from observations that PCI can follow bouts of vigorous coughing. Further hinting at a pulmonary source for this abdominal phenomenon is the rather common association in adults between chronic obstructive lung disease and PCI—suggesting that gas escaping from an alveolar tear could dissect downward along the aorta, to invade the gut wall via mesenteric vessels. Other etiologic factors that have been proposed are gas entry through a rent in the bowel's mucosa, or (in the presence of enteritis) intramural gas production by bacteria.1

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