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Massive pneumatosis intestinalis: CT diagnosis
L D Ryback1, R S Shapiro, K Carano
1Department of Radiology, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Summary
Pneumatosis cystoides intestinalis, a rare condition with gas-filled cysts in the bowel wall, can mimic free intra-abdominal air. Recognizing this condition is crucial for accurate diagnosis and patient management.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Pathology
Background:
- Pneumatosis cystoides intestinalis (PCI) is a rare condition involving gas-filled cysts in the intestinal wall.
- It is associated with various intra- and extra-abdominal conditions and can present asymptomatically or with obstructive symptoms.
Observation:
- A case of massive PCI in the transverse colon was identified in a 47-year-old obese female.
- The patient also had a small amount of free intraperitoneal air, complicating the clinical presentation.
Findings:
- Radiographic findings of free air in the abdomen can be a diagnostic dilemma, especially with comorbid conditions.
- PCI can mimic free intra-abdominal air, leading to potential misdiagnosis of intestinal perforation.
Implications:
- This case underscores the importance of considering PCI in patients with unexplained abdominal symptoms and radiographic free air.
- Accurate identification of PCI is vital to differentiate it from surgical emergencies like bowel perforation and guide appropriate management.