A 75-year-old man presented to our facility with a 5-day history of hematemesis. He reported a left inguinoscrotal hernia that had been present since 1990. Physical examination demonstrated an incarcerated inguinoscrotal hernia. Abdominal computed tomography revealed the stomach, small, and large bowel in the hernia. Esophagogastroduodenoscopy revealed food and brownish liquid in the stomach. Neither the antrum nor the pylorus could be identified during the esophagogastroduodenoscopy, consistent with an incarcerated portion of the stomach. Blood was not seen in the examined portion of the gastrointestinal tract. He was emergently treated with surgical intervention.
Pneumatosis cystoides intestinalis (PCI) is defined by the presence of gas within the bowel wall. It is often asymptomatic and usually benign but may be associated with significant morbidity and mortality. In this patient, PCI was found incidentally on screening colonoscopy, and biopsy of the affected mucosa resulted in deflation of a cyst. Pneumoperitoneum was then identified on subsequent CT. Because pneumoperitoneum is associated with bowel perforation in most cases, it is often treated as an indication for operation. This case of benign and asymptomatic pneumoperitoneum was managed conservatively without complications. Clinicians should be able to identify PCI as a potentially benign finding on colonoscopy as well as a potentially benign cause of pneumoperitoneum. This understanding presents an opportunity to avoid the unnecessary morbidity and costs associated with surgical exploration or additional endoscopic procedures.
gastrosplenic fistulas showed similar survival of 82% in all cases of gastrosplenic fistulas. However, in recent times safety and efficacy of PCD has been well established. PCD has been attempted in prior reports with gastrosplenic fistula but required surgery for definitive management. The choice of surgery is generally open splenectomy with partial gastric resection but laparoscopic techniques have been described. [2491] Figure 1. (a) Large splenic abscess with loss of fat planes with stomach (b) Resolution of abscess with double pigtail catheters (c) Gastrosplenic fistula opening seen in body of stomach on endoscopy (d) Healed gastric wall after 6 weeks of initial presentation.
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