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: 
03 Oct 2021
Reviewer's report:
Thank you for the submission of your manuscript. I have the following
recommendations:
1. Please clarify if your patient was diagnosed with pneumoperitoneum on
presentation. It appears that the patient presented with colonic distension in the
setting of constipation, and underwent exploratory laparoscopic surgery which
revealed PCI, but there is no evidence of pneumoperitoneum on CT imaging. So
PCI resolved with conservative management, but the patient never had
pneumoperitoneum. 
2. The introduction should be more clearly laid out. You introduce the hypothesis
for the mechanism of PCI, but then step back and talk of the two types (primary
vs secondary). However, there is no explanation for what those two types are.
This needs to be clarified. And from your description of the case, this appears to
be primary PCI, which should also be explicitly stated in the discussion.
3. More information regarding the patient's initial presentation would be helpful.
When was his last bowel movement / was he able to pass flatus / where there any
changes to his stool? Also, beyond imaging and surgery, were any other
diagnostic studies sent (such as stool panels for C. diff or other infections given
his stated long term glucocorticoid exposure)?
4. There are some studies that try to use vital signs with laboratory findings
(such as lactic acid) to try and prognosticate PCI; mentioning these would
strengthen the manuscript.
5. Why was etoposide postulated as the primary culprit? Given that PD-1
inhibitors are linked with a variant of colitis also seems like a reasonable
mechanism of injury for primary PCI (and PCI is associated with IBD).
However, if the authors could support that there was no clear history
(mucous/prior bloody bowel movements/inflammatory appearance) more
commonly associated with the adverse effects of PD-1 inhibitors, it would be
beneficial. Similarly, did the other manuscripts that were reviewed with
etoposide present in a similar manner (with abdominal pain and constipation)?
6. For images, I was unable to see the red arrows described in the CT imaging
legend.
Overall, I would recommend significant revisions highlighting the points above.
I would also recommend review/editing for English/language issues.
And again, I would like to thank the authors for submission of the manuscript.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
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Yes
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Yes
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Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes