Pneumatosis cystoides intestinalis associated with massive free air mimicking perforated diffuse peritonitis

Abstract

While pneumatosis cystoides intestinalis (PCI) is a rare disease entity associated with a wide variety of gastrointestinal and non-gastrointestinal disorders, PCI associated with massive intra-and retroperitoneal free air is extremely uncommon, and is difficult to diagnose differentially from perforated peritonitis. We present two cases of PCI associated with massive peritoneal free air and/or retroperitoneal air that mimicked perforated peritonitis. These cases highlight the clinical importance of PCI that mimics perforated peritonitis, which requires emergency surgery. Preoperative imaging modalities and diagnostic laparoscopy are useful to make an accurate diagnosis.

Pneumatosis Cystoides Intestinalis: Clinical Experience in a Single Center

“…In PCI, no pronounced correlation has been established among the area of involvement, clinical findings and severity of the disease. PCI may rarely lead to a mortal scenario, including peritonitis or sepsis (19). Such non-specific symptoms as abdominal pain, abdominal distension, nausea-vomiting, diarrhea, constipation, rectal bleeding, tenesmus, and weight loss may be observed in PCI (11).…”

“…PAXR, USG, CT, endoscopic imaging modalities and double-contrast colon radiography may prove beneficial in the diagnosis (11). Similarly, PAXR is an easily applicable method which is quite useful in the diagnosis of PCI; moreover, presence of circular gas in the bowel and the mesentery is characteristic of PCI (19). In CT views, presence of gas entrapped within the wall of the bowel is characteristic to PCI; CT can also reveal gas bubbles within the intestinal lumen (4).…”

“…The clinical scene of PCI was reported to improve as the factors responsible in the etiology were abolished (23). What has been recommended in the conservative treatment is nasogastric decompression, administration of metronidazole as antibiotherapy and hyperbaric oxygen therapy for absorption of the gas accumulated within the intestinal wall (6,12,19). The rate of mortality was reported to range from 22% to 50% in the cases followed up due to the diagnosis of PCI and who did not undergo surgery (24,25).…”

An unusual case of air within the bladder wall: Bladder pneumatosis?

“…It has been reported in a wide spectrum of pathological circumstances, including intestinal obstruction, bowel ischemia, inflammatory bowel disease, chronic pulmonary disease and bacterial or viral infections related to PCI. 5,6 Furthermore, patients receiving chronic systemic chemotherapy might be susceptible to the development of the disease. 4 None of the theories proposed to explain PCI or EC can fully account for the characteristic features of this case.…”

Pneumatosis intestinalis in an adult: a report of an unusual case

“…In PI presence of intraperitoneal free air and/ or retro-peritoneal air is very uncommon with few reported cases. 8 The etiopathogenesis of PI is uncertain and three main theories have been suggested 4 :…”