Pneumatosis Cystoides Intestinalis Identified on Screening Colonoscopy With Associated Pneumoperitoneum

Abstract

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.

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review

“…Endoscopic procedures are important to investigate the presence of submucosal cysts and exclude the presence of associated pathologies or differential diagnoses, such as lymphoma, liquid cysts, dysbacteriosis, carcinoma, inflammatory disease, polyps, and polyposis 27 . During colonoscopy, polypoid grape-like masses protruding through the mucosa may be indicative of PCI 49 . Such findings should be biopsied, and polyposis or neoplasia should be excluded.…”

Idiopathic Chronic Pneumatosis Cystoids Intestinalis with Benign Pneumoperitoneum: A Rare Endoscopic Finding

“…PCI is characterized by the presence of gas, forming multilocu- lar cysts, in the intestinal wall ranging from an incidental finding to a life-threatening intra-abdominal condition [1,2]. In 85% of cases, PCI is secondary to several conditions including immunological disturbances, infections, pulmonary disorders and diseases affecting gastrointesti-nal motility [3,4]. In these cases, the main symptoms and also treatments are related to the primary disease.…”