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Pneumatosis cystoides intestinalis with free intraperitoneal air: a case report
Joanna Hwang1, V Sreenath Reddy, Kenneth W Sharp
1Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2577, USA.
Abstract:
Pneumatosis cystoides intestinalis (PCI) is a rare disorder of the medical management and clinical outcome of which largely depend on the severity of its clinical manifestation. A limited number of cases have been reported in the literature although it is suggested that the true incidence of this disorder is higher than observed in clinical practice. This is the case of a 76-year-old woman with a past medical history of Crohn's disease found to have PCI. The patient initially complained of abdominal pain, distention, and weight loss. Chest and abdominal radiographs demonstrated free intraperitoneal air. CT scans revealed characteristic air-filled cysts in the intestinal wall, which established the diagnosis of PCI. Because the patient did not have an acute abdomen or findings requiring emergency laparotomy she was treated nonoperatively with supportive care. Her symptoms resolved gradually over several days. The patient was discharged home in stable condition tolerating a regular diet and was doing well at follow-up. The sole finding of free air with PCI does not mandate exploratory laparotomy.
Insights
Pneumatosis cystoides intestinalis (PCI) is a rare condition. This case shows that free air on imaging does not always require surgery for PCI, with supportive care being effective.
Area of Science:
- Gastroenterology
- Radiology
- Internal Medicine
Background:
- Pneumatosis cystoides intestinalis (PCI) is a rare condition.
- Its clinical management and outcomes depend on manifestation severity.
- True incidence may be higher than reported cases suggest.
Observation:
- A 76-year-old woman with Crohn's disease presented with abdominal pain, distention, and weight loss.
- Radiographs showed free intraperitoneal air; CT confirmed intestinal wall cysts, diagnosing PCI.
- The patient lacked an acute abdomen, indicating nonoperative management was suitable.
Findings:
- Nonoperative management with supportive care led to gradual symptom resolution.
- The patient was discharged in stable condition and showed good follow-up results.
- Free air in PCI cases does not automatically necessitate exploratory laparotomy.
Implications:
- This case highlights that nonoperative management can be successful for select PCI patients.
- It suggests a less invasive approach may be appropriate when acute surgical findings are absent.
- Emphasizes the importance of individualized treatment based on clinical presentation in rare disorders like PCI.