Gastric Outlet Obstruction and Sigmoid Volvulus in a Patient withPneumatosis intestinalis: An Etiology or a Complication

Abstract

Pneumatosis intestinalis (PI) is a radiographic finding which refers to the presence of gas within the wall of any part of the gastrointestinal tract. While in some cases it is an incidental finding which usually represent its benign nonischemic etiology, it may indicate a catastrophic intra-abdominal condition and distinctly characteristic of ischemic enterocolitis. Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management and outcome of an extremely rare concurrent triad of PI, gastric outlet obstruction, and the sigmoid volvulus based on a case of a patient who underwent surgery in our hospital, which, we think, can emphasize the mysterious concept of PI’s mechanical etiology.

Acute abdomen with gastric volvulus revealing an underlying pneumatosis cystoides intestinalis: a case report

“…Multiple theories regarding explanation of PCI were introduced in the literature, including mechanical, pulmonary, bacterial and biochemical theories [ 12 ]. The mechanical theory is the most compatible with our case; Two main mechanisms are used to explain this theory: mucosal injury and increased intraluminal pressure.…”

“…Our patient had a past history of a surgically repaired duodenal ulcer; PUD was mentioned in the literature as a common cause of PCI [ 12 ] and numerous papers reported an association between PCI and gastric outlet obstruction (pyloric stenosis) [ 12 , 13 ]. In our case the stenosis was accompanied by a gastric volvulus and complicated by tearing of the anterior and posterior gastric walls; which is a new, unprecedent clinical scenario related to PCI.…”

Sigmoid volvulus and concomitant clinical entities

“…[53] Hiatal hernia is another rare cause of SV, in which hiatal gap is the entrapping factor. [54] Pneumatosis cystoides intestinalis, the presence of gas cysts in the bowel wall, is both a rare cause [55] and a rare complication [56] of SV with unexplained pathophysiology. Brown bowel syndrome (lipofuscinosis) is another rare cause of SV, in which oxidative stress arising from malnutrition causes necrosis and autophagy of smooth muscles resulting in atonia.…”