Review for 10.1186/s12876-022-02219-8 (2022)

Reviewer’s report
Title: 
Pneumatosis cystoides intestinalis associated with etoposide in
hematological malignancies: A case report and a literature review
Version: 
0 
Date: 
02 Jan 2022
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
My overall impression is very good with good description and interpretation of
the report and clearly outlined novelty.
Relevance: This report contributes to medical knowledge.
Case Description: Please kindly provide the details of the laboratory tests with
complete blood count, CRP/ESR or other inflammatory markers if available.
Diagnosis/Interpretation: The work described is medically sound.
Case Discussion: If possible and feasible detailed operative findings with areas
of colon or mesocolon predominantly involved such as right and transverse
colon in earlier reported cases and add laparoscopy as potential modality for
therapeutic approach at least for initial diagnostic and assessment of the extent of
the disease and gastrointestinal endoscopy may aggravate the PI/PCI due to
increased intraluminal pressure. As recently described in a similar case report
given below:
Patel RV, Sutton PA, Colliver D, Stewart R: Pneumoperitoneum and
pneumatosis cystoides intestinalis (PCI) following chemotherapy in an
adolescent with Hodgkin's lymphoma. BMJ Case Reports 23 February 2014;
doi:10.1136/bcr-2013-203433
REQUESTED REVISIONS: 
The pathogenesis of PCI in this case is secondary and remains to be explored
involving following possible major hypotheses: mechanical theory (by increased
intraluminal colonic gas and pressure due to adynamic febrile or septic ileus
increasing the colonic luminal pressure leading to relative ischemia on the
mesocolon side of the lumen allowing leakage of air), bacterial theory (bacterial
transudation via relative ischemic zone and reduced immunity by chemotherapy
medications) and chemical theory (toxic effects of chemotherapy on the cell
adhesion and apoptosis) or nutritional deficiency theory (depletion of
micronutrients in these debilitated patients).
1. Title, abstract and introduction is very good.
2. In the case report if possible and feasible complete blood counts and
inflammatory markers at admission may be added and the operative detailed
findings as to what areas were exactly involved as most cases happens in
pediatric and geriatric cases and most cases part of the colon and terminal ileum
is involved possible due to temporary ileocecal reflux and more lesions are seen
involving right and transverse colon and mesocolon and even in the review cases
these details if available will provide a definite pattern and possible ileus
involving left colon as more cases are seen in neurotoxicity chemotherapy
agents.
3. In the discussion, possible pathogenesis mechanism in this case, role of
laparoscopy and addition of one more recent reference will do.
ADDITIONAL REQUESTS/SUGGESTIONS: 
Overall the case report and review of literature is very good except for minor
revisions indicated.
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