Pneumoperitoneum in a non-acute abdomen—pneumatosis cystoides intestinalis

Abstract

AimThe aim of this study is to increase the understanding of pneumatosis cystoides intestinalis (PCI) and its incidents.MethodWe report here a case of PCI in an 88-year-old man with a provisional diagnosis of perforated viscus and possible ischaemic bowels based on CT findings of pneumoperitoneum. The patient was found to have extensive PCI on his small bowels. We then systematically search the PubMed database for case reports for articles containing ‘pneumatosis intestinalis’ in their titles or key words.ResultsThe study group consisted of 52 cases on PCI from the period of 2010–2014 with the focus on the adult population. The youngest patient was 18 years old and the oldest was 91 years old. The mean age was 60.4 years (range, 18–91 years old). There were 27 (52 %) females and 25 (48 %) males. The most common symptoms were abdominal pain (79 %) followed by nausea/vomiting (27 %) and abdominal distension (19 %). CT imaging was the most common investigation modality used (94 %). Three (6 %) of the patients had laparoscopic treatment while 20 (38 %) had laparotomy. Thirty-six (69 %) of them recovered uneventfully while 9 (17 %) of the patients died.ConclusionAlthough there have been more case reports published on PCI in the recent years, the understanding of this condition remains in the infancy stage. PCI can be difficult to diagnose and can be easily misdiagnosed as pneumoperitoneum in an acute abdomen. Often it is identified incidentally during operation. Asymptomatic PCI should be treated conservatively, while emergency laparotomy should be reserved for life threatening abdominal pathology.

Asymptomatic pneumoperitoneum or pneumatosis cystoides intestinalis? Easy to make a mistake

“…4 ). PCI can easily mimic pneumoperitoneum on radiological imaging as CT, being a very sensitive examination, may show even minimal circumferential gas collections outside the bowel lumen or misrepresent some findings [ 5 ]. Liu et al .…”

“…Surgery should be instead reserved for management of pneumatosis intestinalis secondary to life-threatening conditions that account for about 3% of all cases [ 9 , 12 ]. To date there has been no randomized controlled trial and only few systematic reviews that specifically analyze PCI [ 5 , 11 ].…”

Pneumatosis cystoides intestinalis: a case report

“…PCI is a rare condition in which gas-containing cysts are formed beneath the intestinal mucosa and serosa and that has an unknown origin [2][3][4] . It is a pathology that mainly affects men, with a ratio of 3.5:1 with respect to women 4 .…”

Neumoperitoneo no quirúrgico

“…Los síntomas son inespecíficos, incluyen dolor abdominal, distensión, estreñimiento, diarrea hemorrágica, tenesmo 1,7 . El hallazgo puede ser incidental al realizar estudios de imagen 10 .…”

“…No hay una causa específica en la etiología de la neumatosis, dentro de las causas de este padecimiento se han identificado algunos medicamentos, como corticoesteroides e inmunosupresores, sin embargo, puede estar relacionada con enfermedades pulmonares, gastrointestinales, infecciosas y autoinmunes 6 . La teoría mecánica propone que el aumento en la presión intraluminal fuerza el paso del gas intraluminal a la pared intestinal 10 . Existen casos documentados de neumatosis coli posterior a preparación colónica para colonoscopia 12 .…”