Cocaine Induced Gastric Ischemia

Pneumatosis intestinalis (PI) describes the presence of gasfilled cysts within the wall submucosa and subserosa of the bowel [1]. Many theories on the etiology of this condition exist, and potential sources of gas include-1. intraluminal gas entering the mucosa secondary to increased intraluminal pressure; 2. bacterial production of H2 gas, where the tension of H2 is greater than the tension of nitrogen in the blood, causing diffusion of gas from the gut lumen towards submucosal vessels; 3. pulmonary gas, where gas from ruptured alveoli tract along vasculature in the mediastinum caudally to the retroperitoneum and bowel mesentery [2]. The gas can embolize from the bowel wall through the mesenteric veins to the portal venous system and the nondependent parts of the liver. Thus, benign etiologies exist for pneumatosis and studies suggest that half of all patients with PI on CT were successfully managed non-operatively [3-5]. Findings of abdominal distension on physical exam and dilated loops of bowel on CT, lactic academia, and peritonitis are uncommon in patients managed non-operatively [5]. Although the presence of portal venous gas should heighten concern, it should not always Volume 5 Issue 1 2018