Surgical treatment of pneumatosis cystoides intestinalis with pneumoperitoneum secondary

Abstract

We read with great interest the article by Kaya B. et al.(1) (Turk J Gastroenterol 2014; 25: 426-8) entitled "Pneumatosis cystoides intestinalis mimicking acute abdomen". The authors reported a case of pneumatosis cystoides intestinalis (PCI) with pneumoperitoneum.They insisted that uncomplicated PCI can be safely managed conservatively but that bowel necrosis, perforation, or persistent obstruction should be treated with surgery. We agree with their strategy for treating PCI, but little is known about long-term outcomes after conservative therapy. We present a case of PCI with pneumoperitoneum secondary to sigmoid volvulus following one year of follow-up.A 91-year-old female visited our hospital with complaints of high fever and abdominal pain. She was diagnosed as having acute pyelonephritis and PCI, which was incidentally diagnosed in the computed tomography (CT) scan that revealed a dilated colon and numerous cystic gas (Figure 1,2). Acute pyelonephritis improved with conservative therapy using antibiotics, and PCI disappeared. Then, she was followed up as an outpatient. Thirteen months later, she presented to our hospital again with complaints

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

“…A multidisciplinary evaluation with a physician, radiologist, and surgeon is effective to determine the benign and spontaneous origin of pneumoperitoneum and to avoid unnecessary invasive procedures 12,14,17,20,47,48 . Pathological examination of the resected cyst wall often shows a chronic inflammatory process 3 .…”

“…Ischemia and hollow visceral perforation should be excluded 6,7,11,16,20,24,26,42,44,45 . Long-term outcomes are still not well known, with reports of complications that may or may not be associated with PCI, such as intestinal ischemia secondary to volvulus 24,47 .…”