Pneumatosis cystoides intestinalis with pneumoperitoneum in an 87-years-old male patient: a case report

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. The mesentery and intra-abdominal ligaments can be affected. PCI is classified as primary or secondary and associated with multiple predisposing factors. An asymptomatic 87-year-old man underwent an abdominal tomography for follow-up of bladder carcinoma. The examination revealed intestinal and mesenteric pneumatosis associated with pneumoperitoneum. At laparoscopy, intestinal and mesenteric pneumatosis without intestinal infarction was identified. He was discharged on the fifth postoperative day. PCI is a benign condition that can be confused with mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is unnecessary for its diagnosis or management.

Intestinal pneumatosis: a problem of misdiagnosis

“…La patogenia es multifactorial y su etiología variada, entre las cuales se encuentran: enfermedades digestivas (isquemia intestinal, megacolon tóxico), pulmonares (enfisema, fibrosis quística), sistémicas (SIDA, esclerodermia), iatrogenia, pudiendo ser asociadas a trasplantes o fármacos, aun cuando en 15 % de los casos, no se encuentra causa relacionada. (12) Del mismo modo, como aún no está bien comprendida la patogenia de la enfermedad, se conocen entre sus orígenes las siguientes: bacteriano, mecánico, bioquímico y pulmonar, (13) donde la IP afecta clásicamente al tracto digestivo, con rara afectación del mesenterio, epiplón y ligamento hepatogástrico. Esta condición causa un amplio espectro de síntomas no específicos, donde el 3 % de los casos puede estar asociado a complicaciones, como volvus, perforación, hemorragia y obstrucción.…”

Endoscopic Ultrasound View of Pneumatosis Cystoides Intestinalis

“…These lesions were homogeneously distributed over the entire circumference of this intestinal segment. PCI is classified into primary (idiopathic) and secondary forms, with 15% and 85% of presentations, respectively [1,2]. A 45-year-old female patient with a medical history of constipation and recurrent diverticulitis presented herself for an elective colonoscopy eight weeks after her last episode.…”

“…These lesions were homogeneously distributed over the entire circumference of this intestinal segment. PCI is classified into primary (idiopathic) and secondary forms, with 15% and 85% of presentations, respectively [ 1 , 2 ].…”