Pneumorrhachis, Subcutaneous Emphysema, Pneumomediastinum, Pneumopericardium, and Pneumoretroperitoneum After Proctocolectomy for Ulcerative Colitis

Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
Diseases of the Colon & Rectum (Impact Factor: 3.75). 05/2002; 45(4):567-70. DOI: 10.1007/s10350-004-6241-x
Source: PubMed


This article presents the first known case of pneumorrhachis (spinal air), pneumomediastinum, pneumopericardium, pneumoretroperitoneum, and subcutaneous emphysema after proctocolectomy for ulcerative colitis. We review the patient's medical history, clinical and laboratory findings, radiographic data, and operative records, as well as the relevant literature. We describe the case of a young male with ulcerative colitis who developed pneumorrhachis, subcutaneous emphysema, pneumoretroperitoneum, pneumomediastinum, and pneumopericardium after a proctocolectomy with ileal pouch-anal anastomosis. Unlike the case we report, previously described episodes of pneumomediastinum and subcutaneous emphysema in patients with ulcerative colitis developed before operative intervention. We offer possible explanations for these unusual complications based on analysis of this case and thorough review of the literature.

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    • "Based on the etiology, PR can be broadly classified into iatrogenic, nontraumatic, and traumatic. Iatrogenic PR can be a result of surgical interventions, anesthetic techniques, and diagnostic techniques [5] [11] [12]. Nontraumatic causes of intraspinal air include malignancy and its associated therapy [13], violent coughing because of bronchial asthma or acute bronchitis [14] [15], single cases have been described in the literature after cardiopulmonary resuscitation, airway obstruction because of foreign body aspiration [16], two cases after physical exertion [17], inhalation drug abuse of 3,4-methylenedioxymethamphetamine (ecstasy) [18] or marijuana [19]. "
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    ABSTRACT: Traumatic pneumorrhachis (PR) is a rare entity, consisting of air within the spinal canal. It can be classified as epidural or subarachnoid, identifying the anatomical space where the air is located, and is associated with different etiologies, pathology, and treatments. To conduct a systematic review of the scientific literature focused on the etiology, pathomechanism, diagnosis, and treatment of PR, and to report a case of an asymptomatic epidural type. International medical literature has been reviewed systematically for the term "traumatic pneumorrhachis" and appropriate related subject headings, such as traumatic intraspinal air, traumatic intraspinal pneumocele, traumatic spinal pneumatosis, traumatic spinal emphysema, traumatic aerorachia, traumatic pneumosaccus, and traumatic air myelogram. All cases that were identified were evaluated concerning their etiology, pathomechanism, and possible complications. Studies that included one of the aforementioned terms in their titles. A systematic review was performed to identify, evaluate, and summarize the literature related to the term "traumatic pneumorrhachis" and related headings. Furthermore, we report a rare case of an asymptomatic epidural PR extending to the cervical and thoracic spinal canal. We present the current data regarding the etiology, pathomechanism, diagnosis, and treatment modalities of patients with PR. The literature review included 37 related articles that reported 44 cases of traumatic PR. Only isolated case reports and series of no more than three cases were found. In 21 cases, the air was located in the epidural space, and in 23 cases, it was in the subarachnoid space. Most of the cases were localized to a specific spinal region. However, eight cases extending to more than one spinal region have been reported. Traumatic PR is an asymptomatic rare clinical entity and often is underdiagnosed. It usually resolves by itself without specific treatment. We stress the significance of this information to trauma specialists, so that they may better differentiate between epidural and subarachnoid PR. This is of great significance because subarachnoid PR is a marker of severe injury. The management of traumatic PR has to be individualized and frequently requires multidisciplinary treatment, involving head, chest, and/or abdomen intervention.
    The spine journal: official journal of the North American Spine Society 02/2011; 11(2):153-7. DOI:10.1016/j.spinee.2010.12.010 · 2.43 Impact Factor
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    • "The aetiology of epidural pneumorrhachis has been classified as iatrogenic, spontaneous, and traumatic. Iatrogenic causes are the most common and follow the administration of epidural analgesia or to thoracic, abdominal and spinal surgery (Overdiek et al., 2001; Holton et al., 2002). Spontaneous causes have been described following nontraumatic pneumothorax, pneumomediastinum, or degenerative disc disease (Aribas et al., 2001; Chun and Moon, 2009). "
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    ABSTRACT: A 41-year-old man with injury of right half of the thorax, fractures of the left crural bones and paralysis of the right upper limb was admitted to our hospital. A CT examination at admission revealed bilateral pulmonary contusion and bilateral fluid- and pneumothorax. In addition pneumomediastinum, pneumopericardium, subcutaneous emphysema and pneumorrhachis at the cervicothoracic transition was demonstrated. Abnormal findings in the skull and brain were not revealed. The fifth day after admission repeated CT examination demonstrated extensive frontal pneumocephalus on the right, presence of air in several cisterns and in the right optic nerve sheaths (pneumoopticus). Right frontal craniotomy was performed, dura mater was incised and air was evacuated. Rapid regression of pneomocephalus was evident postoperatively. The tenth day after admission MRI of the cervical spine and brachial plexus was performed. At the level of the C7 and C8, nerve roots pneumomenigocele and a nerve retracting ball indicating the presence of a nerve root injury were discernible. This case demonstrated that severe thoracic blunt trauma leads to acute increase of intrathoracic pressure with concomitant fluid- and pneumothorax, pneumomediastinum and pneumopericard. From the mediastinum air propagated subcutaneously. Disrupted cervical dural sheaths resulted in leakage of cerebrospinal fluid and entry of air from mediastinum to subdural and subarachnoid spinal and cranial space and to the subarachnoid space of the optic nerve.
    Prague medical report 01/2011; 112(1):56-66.
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    ABSTRACT: According to the complex, nonstationary and nonderivative characteristics of partial discharge (PD) ultrasonic signal, the piecewise self-affine iterated function system (IFS) model of PD ultrasonic signals is established. The IFS parameters of this model are calculated to realize data compression. The IFS fractal dimension is extracted based on this model which is provided for partial discharge pattern recognition. The novel route is that both the tasks of compression and feature extraction in a single step, affords a new tool for on-line monitoring of partial discharge in a transformer.
    Power System Technology, 2002. Proceedings. PowerCon 2002. International Conference on; 02/2002
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