Pneumatosis Intestinalis After Colonoscopy in a Crohn’s Disease Patient with Mucosal Healing
Bibliographic record
Abstract
To the Editor: Pneumatosis intestinalis (PI) is defined as the presence of gas within the wall of the gastrointestinal tract. It is associated with conditions such as inflammatory bowel disease (IBD), chronic obstructive pulmonary disease (COPD), acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy, infection, and intestinal ischemia.1 We present the first reported case of PI after colonoscopy in a Crohn’s disease (CD) patient with mucosal healing. Mr. F. is a 22-year-old man with fistulizing CD involving the terminal ileum and perianal abscesses. Since diagnosis in 2001, he had received intermittent courses of corticosteroid and 5-aminosalicylic acid with minimal response. In 2006, he eventually achieved clinical remission with azathioprine and infliximab. Infliximab was subsequently changed to adalimumab due to loss of response. However, the disease recurred in 2009 and he underwent a laparoscopic ileocecal resection. While being maintained on adalimumab 40 mg every 2 weeks and azathioprine 125 mg daily, Mr. F. was assessed for mucosal healing in July 2011. A colonoscopy with biopsies taken at the neoterminal ileum and ileocolonic anastomosis was performed using an adult colonoscope without any technical difficulty or immediate complication. It showed complete endoscopic mucosal healing. Biopsies showed no significant pathologic abnormality. Several hours after discharge, he vomited and developed severe abdominal pain requiring urgent medical assessment. Although afebrile and hemodynamically stable, Mr. F. had an abdominal computed tomography (CT) showing alarming retroperitoneal free air, pneumatosis of the ascending and transverse colon, and small intraperitoneal air (Fig. 1). He was treated conservatively with bowel rest, intravenous fluid, and broad-spectrum antibiotics. He was discharged 6 days after the colonoscopy. He had complete resolution of symptoms when assessed in our outpatient clinic 1 week after discharge.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.015 | 0.009 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".