Pneumatosis cystoides intestinalis presenting as pneumoperitoneum in a patient with chronic obstructive pulmonary disease: a case report

Abstract

BackgroundPneumatosis cystoides intestinalis, marked by numerous gas-filled cysts in the intestinal wall and submucosa or intestinal submucosa, is a very uncommon condition.Case presentationA 79-year-old Asian man presented to our emergency department after 2 days of lower abdominal pain with nausea and constipation. His past medical history included chronic obstructive pulmonary disease and he had been treated with home oxygen therapy. The patient was hemodynamically stable and had mild generalized abdominal pain and a soft, distended abdomen without signs of peritonism. A computed tomography scan showed diffuse intraluminal gas and intraperitoneal free gas. Based on the images, a clinical diagnosis of pneumatosis cystoides intestinalis with pneumoperitoneum was made. Considering the patient’s physical examination, the peritoneal free air was drained by aspiration and he was observed for 12 h, but remained well. Abdominal symptoms and pneumoperitineum resolved after drainage of the peritoneal air by aspiration. The suspected etiopathogenic mechanism of pneumatosis cystoides intestinalis in the presented patient may have been alveolar air leakage secondary to high airway pressure due to chronic obstructive pulmonary disease; air leakage from an alveolar rupture may have traveled to the retroperitoneum through the mediastinal vessels and entered the mesentery of the bowel.ConclusionEmergency physicians should be aware of the potential development of pneumatosis cystoides intestinalis in chronic obstructive pulmonary disease patients.

An asymptomatic case of pneumatosis cystoids intestinalis: A case report

“…PCI can be divided into primary (15%) and secondary (85%) types [5]. Various gastrointestinal and non-gastrointestinal diseases has been considered as causes of secondary types of PCI, such as bowel ischemia [6], inflammatory bowel diseases, bowel infection, gastroduodenal ulcer, necrotizing enterocolitis [5], pyloric stenosis [7], diverticular disease [5], obstructive pulmonary disease [8], drugs (e.g., alpha-glucosidase inhibitors) [9,10], collagen tissue diseases [11,12], acquired immune deficiency syndrome [13] and malnutrition [4,5,14]. Anywhere none of these symptoms and diseases affected our patient, so his type of PCI can be cosidered as primary type.…”

“…In some cases, alveolar gas dissects along the aorta, through the diaphragm and into the mesenteric blood vessels and then becoming trapped in the bowel wall. A support to this theory is the presence in literature of various case reports of PCI in patients with pulmonary diseases [17,18,19]. However, this theory alone doesn't explain the fact that hydrogen, a gas that human cells aren't able to produce, may be represent up to 50% of the gas content within the cysts.…”

Pneumatosis cystoides intestinalis (PCI) in a patient with undiagnosed systemic sclerosis

“…Pulmonary disorders are often associated with the development of PCI but have been excluded in our patient 1. Her haemoglobin A1c was also within normal range excluding diabetes.…”

Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York

“…PI can represent an incidental, benign finding (primary or idiopathic PI, 15% of cases) or a potentially life-threatening gastrointestinal disease (secondary PI, 85% of cases) (4). Secondary PI is frequently associated with chronic obstructive pulmonary disease (COPD) as well as ischemic, necrotic, and obstructive gastrointestinal insults (5,6). PI is a radiographic sign characterized by linear and/or curvilinear gas collections in the intestinal wall and is often indicative of systemic or local pathological processes affecting the bowel wall (7,8).…”