Pneumatosis?

[Guest guest]

http://www.blackwell-synergy.com/doi/abs/10.1034/j.1399-3046.2002.02001.x?journalCode=ptr

Repeated

detection of gas in the portal vein after liver transplantation: A sign of

EBV-associated post-transplant lymphoproliferation?

A. Wallot1,2, Jörg Klepper1, Philippe Clapuyt3, Olaf Dirsch4, Max Malagó5, Reding6, Bernard Otte6 and Etienne M. Sokal2

Wallot MA, Klepper J,

Clapuyt P, Dirsch O, Malagó M, Reding R, Otte JB, Sokal EM. Repeated

detection of gas in the portal vein after liver transplantation: A sign of

EBV-associated post-transplant lymphoproliferation?

Pediatr Transplantation 2002: 6: 332–336. © 2002 Blackwell Munksgaard

Abstract:

A 1-yr-old child presented with intractable

right sided pleural effusion and progressive clinical deterioration

3 weeks after liver transplantation for Alagille Syndrome. He had been

treated successfully for severe acute rejection before. Ultrasound and Doppler

mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal

and intra-thoracic lymphoproliferation was detected, and EBV virus load and

serology were suggestive of primary EBV infection. Liver biopsy revealed

blast-like infiltrates of B-cells, considered diagnostic for post-transplant

lymphoproliferative disease. The disease resolved upon reduction of

immunosuppression. We suggest that the detection of portal vein gas in

pediatric liver transplant recipients beyond the early post-operative period

may be a sign of intra-abdominal post-transplant lymphoproliferative disease.

Ami,

From what I am seeing it looks like the

common thread here is immunosuppression therapy post-transplant.   

I don’t know if someone can get the

full article, but this is just the abstract.

This is from Pediatric Transplantation, so

I don’t know if you see any docs that would share with you.

Much love,

[Guest guest]

http://www.blackwell-synergy.com/doi/abs/10.1034/j.1399-3046.2002.02001.x?journalCode=ptr

Repeated

detection of gas in the portal vein after liver transplantation: A sign of

EBV-associated post-transplant lymphoproliferation?

A. Wallot1,2, Jörg Klepper1, Philippe Clapuyt3, Olaf Dirsch4, Max Malagó5, Reding6, Bernard Otte6 and Etienne M. Sokal2

Wallot MA, Klepper J,

Clapuyt P, Dirsch O, Malagó M, Reding R, Otte JB, Sokal EM. Repeated

detection of gas in the portal vein after liver transplantation: A sign of

EBV-associated post-transplant lymphoproliferation?

Pediatr Transplantation 2002: 6: 332–336. © 2002 Blackwell Munksgaard

Abstract:

A 1-yr-old child presented with intractable

right sided pleural effusion and progressive clinical deterioration

3 weeks after liver transplantation for Alagille Syndrome. He had been

treated successfully for severe acute rejection before. Ultrasound and Doppler

mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal

and intra-thoracic lymphoproliferation was detected, and EBV virus load and

serology were suggestive of primary EBV infection. Liver biopsy revealed

blast-like infiltrates of B-cells, considered diagnostic for post-transplant

lymphoproliferative disease. The disease resolved upon reduction of

immunosuppression. We suggest that the detection of portal vein gas in

pediatric liver transplant recipients beyond the early post-operative period

may be a sign of intra-abdominal post-transplant lymphoproliferative disease.

Ami,

From what I am seeing it looks like the

common thread here is immunosuppression therapy post-transplant.   

I don’t know if someone can get the

full article, but this is just the abstract.

This is from Pediatric Transplantation, so

I don’t know if you see any docs that would share with you.

Much love,

[Guest guest]

http://www.blackwell-synergy.com/doi/abs/10.1034/j.1399-3046.2002.02001.x?journalCode=ptr

Repeated

detection of gas in the portal vein after liver transplantation: A sign of

EBV-associated post-transplant lymphoproliferation?

A. Wallot1,2, Jörg Klepper1, Philippe Clapuyt3, Olaf Dirsch4, Max Malagó5, Reding6, Bernard Otte6 and Etienne M. Sokal2

Wallot MA, Klepper J,

Clapuyt P, Dirsch O, Malagó M, Reding R, Otte JB, Sokal EM. Repeated

detection of gas in the portal vein after liver transplantation: A sign of

EBV-associated post-transplant lymphoproliferation?

Pediatr Transplantation 2002: 6: 332–336. © 2002 Blackwell Munksgaard

Abstract:

A 1-yr-old child presented with intractable

right sided pleural effusion and progressive clinical deterioration

3 weeks after liver transplantation for Alagille Syndrome. He had been

treated successfully for severe acute rejection before. Ultrasound and Doppler

mode studies repeatedly demonstrated air in the portal vein. Intra-abdominal

and intra-thoracic lymphoproliferation was detected, and EBV virus load and

serology were suggestive of primary EBV infection. Liver biopsy revealed

blast-like infiltrates of B-cells, considered diagnostic for post-transplant

lymphoproliferative disease. The disease resolved upon reduction of

immunosuppression. We suggest that the detection of portal vein gas in

pediatric liver transplant recipients beyond the early post-operative period

may be a sign of intra-abdominal post-transplant lymphoproliferative disease.

Ami,

From what I am seeing it looks like the

common thread here is immunosuppression therapy post-transplant.   

I don’t know if someone can get the

full article, but this is just the abstract.

This is from Pediatric Transplantation, so

I don’t know if you see any docs that would share with you.

Much love,

[Guest guest]

Ami,

Now this

one is from an online forum. I don’t know how much weight I would give

it. You don’t have the cystoids in your name, but I am sending it since

you do have the lung issues. Thought it might be of interest.

Subject: Re: Pneumatosis Cystoides Intestinalis

Forum: The Gastroenterology and

Liver Diseases Forum

Topic Area: Colon Surgery

Posted by HFHSM.D.-rf on November 07, 1998 at 12:20:42:

In Reply to: Pneumatosis

Cystoides Intestinalis posted by Steve on November 03, 1998 at 21:02:31:

: I'm looking for any info on this condition... how someone acquires it, types

of treatment, recurrence, long-term problems. I have found very little

information on the topic and would greatly appreciate any info you have. Thank

you for your time.

: Steve

____________

Dear Steve,

Pneumatosis cystoides intestinalis is a condition in which there are gas filled

cysts in the wall of the small intestine. Its associated condition is

pneumatosis coli or gas containing cysts in the colon wall. These condition

usually result from rupture of small air sacs in the lung. The gas that is released

tracks retroperitoneally and accumulates as free gas in the abdominal cavity or

as gas in the bowel wall. Patients with pneumatosis intestinalis or coli often

have underlying lung diseases e.g. emphysema. The abdominal gas collections do

not cause symptoms but must be distinguished from serious intestinal infections

and from a perforated strucutre. Although one can often have a high level of

suspicion whether the problem is pneumatosis, sometimes an exploratory

operation is needed to exclude other intrabdominal conditions that require

different therapies.

If a

physician chooses to treat pneumatosis, the therapy consists of brerathing gas

rich in oxygen. By diffusion, the gas leaves the bowel cysts and oxygen is the

replacement. the oxygen is used for cell metabolism and the cyst collapses.

Obviously, this therapy can not be used for patients with serious underlying

lung conditions.

This

information is presented for educational purposes only. Always ask specific

questions to your personal physician.

HFHSM.D.-rf

*keywords: pneumatosis intestinalis

[Guest guest]

Ami,

Now this

one is from an online forum. I don’t know how much weight I would give

it. You don’t have the cystoids in your name, but I am sending it since

you do have the lung issues. Thought it might be of interest.

Subject: Re: Pneumatosis Cystoides Intestinalis

Forum: The Gastroenterology and

Liver Diseases Forum

Topic Area: Colon Surgery

Posted by HFHSM.D.-rf on November 07, 1998 at 12:20:42:

In Reply to: Pneumatosis

Cystoides Intestinalis posted by Steve on November 03, 1998 at 21:02:31:

: I'm looking for any info on this condition... how someone acquires it, types

of treatment, recurrence, long-term problems. I have found very little

information on the topic and would greatly appreciate any info you have. Thank

you for your time.

: Steve

____________

Dear Steve,

Pneumatosis cystoides intestinalis is a condition in which there are gas filled

cysts in the wall of the small intestine. Its associated condition is

pneumatosis coli or gas containing cysts in the colon wall. These condition

usually result from rupture of small air sacs in the lung. The gas that is released

tracks retroperitoneally and accumulates as free gas in the abdominal cavity or

as gas in the bowel wall. Patients with pneumatosis intestinalis or coli often

have underlying lung diseases e.g. emphysema. The abdominal gas collections do

not cause symptoms but must be distinguished from serious intestinal infections

and from a perforated strucutre. Although one can often have a high level of

suspicion whether the problem is pneumatosis, sometimes an exploratory

operation is needed to exclude other intrabdominal conditions that require

different therapies.

If a

physician chooses to treat pneumatosis, the therapy consists of brerathing gas

rich in oxygen. By diffusion, the gas leaves the bowel cysts and oxygen is the

replacement. the oxygen is used for cell metabolism and the cyst collapses.

Obviously, this therapy can not be used for patients with serious underlying

lung conditions.

This

information is presented for educational purposes only. Always ask specific

questions to your personal physician.

HFHSM.D.-rf

*keywords: pneumatosis intestinalis

[Guest guest]

Ami,

Now this

one is from an online forum. I don’t know how much weight I would give

it. You don’t have the cystoids in your name, but I am sending it since

you do have the lung issues. Thought it might be of interest.

Subject: Re: Pneumatosis Cystoides Intestinalis

Forum: The Gastroenterology and

Liver Diseases Forum

Topic Area: Colon Surgery

Posted by HFHSM.D.-rf on November 07, 1998 at 12:20:42:

In Reply to: Pneumatosis

Cystoides Intestinalis posted by Steve on November 03, 1998 at 21:02:31:

: I'm looking for any info on this condition... how someone acquires it, types

of treatment, recurrence, long-term problems. I have found very little

information on the topic and would greatly appreciate any info you have. Thank

you for your time.

: Steve

____________

Dear Steve,

Pneumatosis cystoides intestinalis is a condition in which there are gas filled

cysts in the wall of the small intestine. Its associated condition is

pneumatosis coli or gas containing cysts in the colon wall. These condition

usually result from rupture of small air sacs in the lung. The gas that is released

tracks retroperitoneally and accumulates as free gas in the abdominal cavity or

as gas in the bowel wall. Patients with pneumatosis intestinalis or coli often

have underlying lung diseases e.g. emphysema. The abdominal gas collections do

not cause symptoms but must be distinguished from serious intestinal infections

and from a perforated strucutre. Although one can often have a high level of

suspicion whether the problem is pneumatosis, sometimes an exploratory

operation is needed to exclude other intrabdominal conditions that require

different therapies.

If a

physician chooses to treat pneumatosis, the therapy consists of brerathing gas

rich in oxygen. By diffusion, the gas leaves the bowel cysts and oxygen is the

replacement. the oxygen is used for cell metabolism and the cyst collapses.

Obviously, this therapy can not be used for patients with serious underlying

lung conditions.

This

information is presented for educational purposes only. Always ask specific

questions to your personal physician.

HFHSM.D.-rf

*keywords: pneumatosis intestinalis

[Guest guest]

What I wonder is if this is somehow related to his previous lung disease, depending on how long it's been present. It lists COPD, pulmonary fibrosis being considered one of them. And then we have the immunosuppression and steroids option. Inflammatory bowel disease (the UC I've been asking for a colonoscopy to dx or rule out). It also says this: "pneumatosis has been found secondary to motor vehicle accidents, child abuse, and endoscopy." But I would think that it would be higher up if his were due to the ERCP. Dr. Cass doesn't go any further than the CBD when he does them, and I believe 's is in his colon. Thanks for looking, Marie. How is Noah? Ami a wrote: This one seemed a tad bit more reader friendly. I will keep looking. All the best Ami. Big HUGS too. http://www.emedicine.com/RADIO/topic560.htm Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Malabsorption, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, RAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ __________________________________________________

[Guest guest]

What I wonder is if this is somehow related to his previous lung disease, depending on how long it's been present. It lists COPD, pulmonary fibrosis being considered one of them. And then we have the immunosuppression and steroids option. Inflammatory bowel disease (the UC I've been asking for a colonoscopy to dx or rule out). It also says this: "pneumatosis has been found secondary to motor vehicle accidents, child abuse, and endoscopy." But I would think that it would be higher up if his were due to the ERCP. Dr. Cass doesn't go any further than the CBD when he does them, and I believe 's is in his colon. Thanks for looking, Marie. How is Noah? Ami a wrote: This one seemed a tad bit more reader friendly. I will keep looking. All the best Ami. Big HUGS too. http://www.emedicine.com/RADIO/topic560.htm Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Malabsorption, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, RAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ __________________________________________________

[Guest guest]

What I wonder is if this is somehow related to his previous lung disease, depending on how long it's been present. It lists COPD, pulmonary fibrosis being considered one of them. And then we have the immunosuppression and steroids option. Inflammatory bowel disease (the UC I've been asking for a colonoscopy to dx or rule out). It also says this: "pneumatosis has been found secondary to motor vehicle accidents, child abuse, and endoscopy." But I would think that it would be higher up if his were due to the ERCP. Dr. Cass doesn't go any further than the CBD when he does them, and I believe 's is in his colon. Thanks for looking, Marie. How is Noah? Ami a wrote: This one seemed a tad bit more reader friendly. I will keep looking. All the best Ami. Big HUGS too. http://www.emedicine.com/RADIO/topic560.htm Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Malabsorption, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, RAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ __________________________________________________

[Guest guest]

-----Original

Message-----

Okay, my extended GI family . . . Does anyone have information

about Pneumatosis?

I just got a phone call from his nurse saying it's a pneumostosis

Ami,

Do you have the

correct spelling?

In your subject line

you spelled it “Pneumatosis” –

which means gas in the bowel wall, often first identified on abdominal

radiographs or Ct scans.

In the body of your

e-mail you spelled it “pneumostasis” –

which means an air leak usually following pulmonary surgery.

I can

be more helpful if I know which one we are talking about.

Barb

in Texas

[Guest guest]

It's the pneumAtosis. I apologize for the mix-up. Here's what we have so far, after talking with the docs. The surgeon said he doesn't think will end up needing surgery to fix it (which in 's world means he probably will). He also said (after some coaxing to get the answer out of him) that IF allowing his colon to rest, this doesn't resolve, that portion of the bowel will need to be removed, because apparently the pneumatosis can basically kill off that portion of the intestine. He's being put back on TPN, which, of course, kills me. It should only be for a few days. But I'm not sure how long I give it before it becomes more of a detriment to his already very damaged and cirrhotic (sp?) liver and I start asking about doing surgery instead. I mean, it's a pretty big surgery, but can't afford any further damage, either. They've changed all his meds but the prograf to IV. And they're only putting the prograf in his j-tube still to avoid having to give him a periferal IV to go with the double PICC line he already sports. (He already had about a dozen meds and now a few more have been added, all now IV, and several not compatible with each other in that form.) Dr. Sharp said it was likely from a bacterial infection and he maybe had had an ulceration in his colon that the bacteria aggrevated, so we're obviously running stool cultures now (contact precautions again - yeah!), and that he read through the ERCP report from last week and there's nothing to indicate that it was the culprit. Which brings me to become even MORE irritated that the colonoscopy I've been asking for for WEEKS has not been done, if it WAS from an ulceration. Or from UC (which is on the list of possible causes, also). Anyway, enough

of my rambling. Except I have to say that with his Diabetes Insipidus, the poor kid is SO miserable being NPO. And, of course, with the Diabetes Mellitus, his blood sugars have been running higher because of the new stress his body is currently under. Grrr. AmiBarb Henshaw wrote: -----Original

Message-----Okay, my extended GI family . . . Does anyone have information about Pneumatosis? I just got a phone call from his nurse saying it's a pneumostosis Ami, Do you have the correct spelling?

In your subject line you spelled it “Pneumatosis” – which means gas in the bowel wall, often first identified on abdominal radiographs or Ct scans. In the body of your e-mail you spelled it “pneumostasis” – which means an air leak usually following pulmonary surgery.

I can be more helpful if I know which one we are talking about. Barb in Texas Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Malabsorption, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, RAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.

[Guest guest]

It's the pneumAtosis. I apologize for the mix-up. Here's what we have so far, after talking with the docs. The surgeon said he doesn't think will end up needing surgery to fix it (which in 's world means he probably will). He also said (after some coaxing to get the answer out of him) that IF allowing his colon to rest, this doesn't resolve, that portion of the bowel will need to be removed, because apparently the pneumatosis can basically kill off that portion of the intestine. He's being put back on TPN, which, of course, kills me. It should only be for a few days. But I'm not sure how long I give it before it becomes more of a detriment to his already very damaged and cirrhotic (sp?) liver and I start asking about doing surgery instead. I mean, it's a pretty big surgery, but can't afford any further damage, either. They've changed all his meds but the prograf to IV. And they're only putting the prograf in his j-tube still to avoid having to give him a periferal IV to go with the double PICC line he already sports. (He already had about a dozen meds and now a few more have been added, all now IV, and several not compatible with each other in that form.) Dr. Sharp said it was likely from a bacterial infection and he maybe had had an ulceration in his colon that the bacteria aggrevated, so we're obviously running stool cultures now (contact precautions again - yeah!), and that he read through the ERCP report from last week and there's nothing to indicate that it was the culprit. Which brings me to become even MORE irritated that the colonoscopy I've been asking for for WEEKS has not been done, if it WAS from an ulceration. Or from UC (which is on the list of possible causes, also). Anyway, enough

of my rambling. Except I have to say that with his Diabetes Insipidus, the poor kid is SO miserable being NPO. And, of course, with the Diabetes Mellitus, his blood sugars have been running higher because of the new stress his body is currently under. Grrr. AmiBarb Henshaw wrote: -----Original

Message-----Okay, my extended GI family . . . Does anyone have information about Pneumatosis? I just got a phone call from his nurse saying it's a pneumostosis Ami, Do you have the correct spelling?

In your subject line you spelled it “Pneumatosis” – which means gas in the bowel wall, often first identified on abdominal radiographs or Ct scans. In the body of your e-mail you spelled it “pneumostasis” – which means an air leak usually following pulmonary surgery.

I can be more helpful if I know which one we are talking about. Barb in Texas Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Malabsorption, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, RAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.

[Guest guest]

It's the pneumAtosis. I apologize for the mix-up. Here's what we have so far, after talking with the docs. The surgeon said he doesn't think will end up needing surgery to fix it (which in 's world means he probably will). He also said (after some coaxing to get the answer out of him) that IF allowing his colon to rest, this doesn't resolve, that portion of the bowel will need to be removed, because apparently the pneumatosis can basically kill off that portion of the intestine. He's being put back on TPN, which, of course, kills me. It should only be for a few days. But I'm not sure how long I give it before it becomes more of a detriment to his already very damaged and cirrhotic (sp?) liver and I start asking about doing surgery instead. I mean, it's a pretty big surgery, but can't afford any further damage, either. They've changed all his meds but the prograf to IV. And they're only putting the prograf in his j-tube still to avoid having to give him a periferal IV to go with the double PICC line he already sports. (He already had about a dozen meds and now a few more have been added, all now IV, and several not compatible with each other in that form.) Dr. Sharp said it was likely from a bacterial infection and he maybe had had an ulceration in his colon that the bacteria aggrevated, so we're obviously running stool cultures now (contact precautions again - yeah!), and that he read through the ERCP report from last week and there's nothing to indicate that it was the culprit. Which brings me to become even MORE irritated that the colonoscopy I've been asking for for WEEKS has not been done, if it WAS from an ulceration. Or from UC (which is on the list of possible causes, also). Anyway, enough

of my rambling. Except I have to say that with his Diabetes Insipidus, the poor kid is SO miserable being NPO. And, of course, with the Diabetes Mellitus, his blood sugars have been running higher because of the new stress his body is currently under. Grrr. AmiBarb Henshaw wrote: -----Original

Message-----Okay, my extended GI family . . . Does anyone have information about Pneumatosis? I just got a phone call from his nurse saying it's a pneumostosis Ami, Do you have the correct spelling?

In your subject line you spelled it “Pneumatosis” – which means gas in the bowel wall, often first identified on abdominal radiographs or Ct scans. In the body of your e-mail you spelled it “pneumostasis” – which means an air leak usually following pulmonary surgery.

I can be more helpful if I know which one we are talking about. Barb in Texas Ami mom to - 8 yrs - Double Lung Tx 2/26/2006, PSC - Pre-Liver Tx, Central DI, Steroid Induced Diabetes, HypoT, GERD, High BP, ADD, Anemia, Malabsorption, No Motility http://www.caringbridge.com/visit/seanfox mom to Emma - 12 yrs - Migraines, otherwise healthy stepmom to - 13 yrs - ADD, RAD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.