Successful conservative treatment of pneumatosis intestinalis associated with intraperitoneal free air: report of a case

Abstract

While pneumatosis intestinalis (PI) is a rare condition associated with a wide variety of underlying diseases, PI with intraperitoneal free air and ascites is extremely uncommon and is difficult to distinguish from diffuse peritonitis. We herein describe the case of an 87-year-old male who was admitted to our hospital with abdominal pain, distension and nausea. Abdominal plain radiography and computed tomography revealed intramural air collection in the entire intestine, intraperitoneal free air and ascites. Although we first suspected bowel necrosis and perforation, his physical findings and the properties of the diagnostic abdominal paracentesis did not support this diagnosis. Therefore, we selected conservative management, and the intramural air, intraperitoneal free air and ascites disappeared 1 week later. Recognition of the possible presence of non-surgical PI and intraperitoneal free air, although it is extremely rare, is important to avoid a misdiagnosis and the associated unnecessary surgical intervention.

Pneumatosis Intestinalis Complicated by Pneumoperitoneum in a Patient with Asthma

“…Short-term antibiotic therapy reduces the risk of recurrence, and it is recommended that antibiotics is continued for 2 months 8 . When pneumoperitoneum is accompanied with PI, surgery is not usually required if there is no severe gastrointestinal symptom or surgical indication 14 , 15 . For patients who do not respond to medical therapy or who develop complication such as intestinal obstruction, surgical option is considered 3 .…”

Pneumatosis Intestinalis and Intestinal Perforation in a Patient Receiving Tocilizumab

“…10 Various reports in the literature described cases of PI-associated pneumoperitoneum which led to unnecessary abdominal surgery, with no evidence of perforation visible at operation. [11][12][13][14] Tocilizumab is associated with an unexplained increased rate of bowel perforation. 15 The British Society for Rheumatology guidelines recommend using tocilizumab with caution in patients with a history of diverticular disease, and suggest that the concomitant use of non-steroidal antiinflammatory drugs or glucocorticoids increases the risk further.…”

Risk factors for bowel necrosis in patients with hepatic portal venous gas

“…Reports of intestinal pneumatosis have also been increasing [ 8 – 13 ]. Wiesner et al [ 9 ] stated that band-like pneumatosis and the combination of pneumatosis and portomesenteric venous gas on CT are highly associated with transmural bowel infarction.…”