Intestinal gas cyst disease

　　The etiology of this disease is not yet clear. Some authors believe that when the gastrointestinal mucosa is damaged, intestinal gas can enter the intestinal wall through the damage. For those with chronic obstructive pulmonary disease, gas may enter the mediastinum from the broken alveoli and reach the mesentery, gastrointestinal ligament, and subserosal layer of the intestinal wall along the aorta and mesenteric blood vessels. Some authors also believe that intestinal gas cysts are caused by bacterial infection in the intestinal wall lymphatic vessels. Some other authors suggest that malnutrition, lack of certain substances or carbohydrate metabolism disorders in the diet may lead to an increase in acidic products in the intestinal lumen, which may increase the permeability of the intestinal mucosa. The acidic products combine with alkaline carbonates in the lymphatic vessels of the intestinal wall to produce carbon dioxide gas, which exchanges with nitrogen in the blood to form gas cysts.

　　Intestinal gas cysts, if associated with peptic ulcers and pyloric stenosis, are located in the jejunum and ileum; if associated with pulmonary diseases, except for the mesentery of the liver and stomach ligament, they mainly gather in the ileocecal area, and if they occur after colonoscopy, they are concentrated in the colon. Subserosal ones resemble soap bubble-like or lymphoma-like, and can exist singly or in clusters, with sizes ranging from a few millimeters to centimeters. Submucosal ones are not easily visible, and the affected intestinal tract feels like a sponge, with the intestinal wall section showing a honeycomb-like appearance. The cyst wall is thin, lined with a single layer of flat or cuboidal epithelial cells, resembling dilated lymphatic vessels. The cysts contain gas, and they do not communicate with each other. The gas composition, except for the low oxygen content, may be related to absorption, and the rest is similar to air.

　　It can lead to complications such as gastrointestinal bleeding, intestinal obstruction, intussusception, pneumoperitoneum, etc. Intestinal paralysis, intussusception, or volvulus, pneumatosis, pneumoperitoneum without the manifestation of peritonitis, can cause peritoneal adhesions, submucosal cysts blocking the intestinal lumen, leading to intestinal obstruction. The duodenal bulb may deform, with incomplete pyloric obstruction, fibrous tissue proliferation between cysts, and infiltration of varying amounts of acute and chronic inflammatory cells.

　　1. This disease is rare, and it is rarely possible to make a diagnosis solely on clinical grounds. For patients with subtle abdominal discomfort, if the abdominal fluoroscopy shows free gas under the diaphragm without peritonitis, the possibility of this disease should be considered. The diagnosis mainly relies on X-ray and endoscopy.

　　2. This disease can occur at any age, but it is more common between the ages of 30 to 50, with more males than females, about three times more than females. 85% of intestinal pneumatosis cystoides are secondary to ulcerative colitis with pyloric obstruction, inflammatory bowel disease, gastrointestinal tumors, and chronic intestinal obstruction, etc. The symptoms are mainly the manifestations of the primary disease. A few cases without other gastrointestinal diseases are called 'primary' intestinal pneumatosis cystoides. At certain stages of the disease, most patients have gastrointestinal symptoms, such as episodic diarrhea lasting for several days or weeks, loose stools containing a lot of mucus and bubbles, abdominal pain accompanied by constipation or thinning of stools, and hematochezia is not uncommon. If the intestinal pneumatosis is extensive in the small intestine, it can cause malabsorption syndrome, and may lead to intestinal paralysis, intussusception, or volvulus. The air bladders may rupture spontaneously, causing pneumoperitoneum without the manifestation of peritonitis. Occasionally, the disease can cause peritoneal adhesions, submucosal cysts blocking the intestinal lumen, leading to intestinal obstruction.

　　3. Fulminant intestinal pneumatosis cystoides often occurs in patients with acute intestinal infection and necrosis of the intestinal wall. Such patients often have autoimmune deficiency, and the clinical manifestations are characterized by significant symptoms of poisoning and peritoneal irritation.

　　Intestinal pneumatosis cystoides is a rare intestinal disease. This disease is characterized by the presence of single, multiple, or tufted air-filled cysts under the serosa of the intestinal wall. It is not advisable to hold family banquets in summer; food should be cooked and eaten immediately. If there is any leftover, it should be boiled thoroughly before eating the next day. However, even when thoroughly boiled, some bacterial toxins cannot be destroyed, such as staphylococcal enterotoxin, which can actively prevent the occurrence of the disease.

　　First, X-ray examination

　　1. The abdominal flat film should be taken in supine and upright positions. It is recommended to clean enema before taking the film. When the air bladders are small and few in number, there are often no characteristic manifestations. If the air bladders are large and numerous, especially when located under the serosa, the following can be seen:

　　(1) The edges of the aerated intestinal loops show clusters or wavy continuous cystic radiolucent areas of varying sizes, from millet to grape size, with a diameter usually 1-2 cm;

　　(2) When the gas cyst breaks and forms pneumoperitoneum, free air can be seen below the diaphragm in the erect film;

　　(3) Intercostal intestinal sign (Chilaiditi) is the accumulation of gas in the space between the diaphragm and the liver or stomach base during flatulence, causing the diaphragm to rise and the liver or stomach base to descend, creating a relatively large gap. The aerated intestines are easy to rise and enter the gap, forming an interposed intestinal loop. The intestines of gas cysts are more likely to form an interposed loop, making the clear cystic radiolucent area of the intestinal wall more apparent. The appearance of this sign is of great help to the diagnosis of the disease.

　　2. X-ray barium meal can further clarify the findings of the plain film and confirm the distribution and range of gas cysts, and often has the following manifestations: there are unevenly sized cystic radiolucent areas at the edge of the barium-filled intestinal lumen, if the gas cyst is under the serosa, the radiolucent area is often located outside the contour of the barium-filled intestinal lumen. If the gas cyst bulges into the intestinal lumen, there is a relatively radiolucent polypoid filling defect at the edge of the intestinal lumen, which should be distinguished from polyps and tumor-like filling defects.

　　Second, fiberoptic endoscopy

　　During endoscopic examination of colonic gas cysts, there are unevenly sized circular protuberances under the mucosa, the mucosal surface is smooth and complete, the base is relatively wide, without pedicle, and the shape of the mass can be changed when it is pressed and squeezed by the body of the endoscope. The examination of living tissue samples is mostly normal mucosa, and the mass can disappear when the cyst is punctured.

　　 Prognosis: Pay attention to dietary habits! Avoid spicy and other foods. Pay attention to health care in daily life. The patient's diet should be light and easy to digest, eat more vegetables and fruits, reasonably match the diet, and pay attention to sufficient nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　Remedy

　　1. Prescription:15g each of codonopsis and pseudostellaria, 30g of astragalus, 10g each of atractylodes, yam, angelica sinensis, chuanxiong, 9g each of tangerine peel and dendrobium, 6g each of moschus (added at the end), ginger half-baked, and licorice. Take for 30 doses consecutively.

　　2. Prescription:6g each of aloes, cyperus rotundus, myrrha, licorice, and myrrha, 9g each of safflower, peach kernel, costus, and trigonella, 12g of ground beetles. After taking 30 doses.

　　3. Prescription:6g each of aloes, cyperus rotundus, myrrha, licorice, and myrrha, 9g each of safflower, peach kernel, costus, and trigonella, 12g of ground beetles. After taking 30 doses.