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Pneumatosis intestinalis: a rare manifestation of acute appendicitis

Hung-Jia Pai1, Chia-Siu Wang, Ching-Chuan Hsieh

  • 1Department of General Surgery, Chang Gung Memorial Hospital, Chia-yi, Chang Gung Institute of Technology, Chang Gung University, Chiayi, Taiwan.

The Journal of Emergency Medicine
|October 27, 2007
PubMed

Insights

Pneumatosis intestinalis (PI), or gas in the bowel wall, is rare. This case shows PI can occur with appendicitis without causing bowel infarction, highlighting the importance of underlying disease severity.

Area of Science:

  • Gastroenterology
  • Surgical Pathology

Background:

  • Pneumatosis intestinalis (PI) is a rare finding characterized by gas within the bowel wall.
  • Cases of PI secondary to acute appendicitis are exceptionally rare, with only two previously reported.
  • This study presents a unique case to expand the understanding of this condition.

Observation:

  • A 46-year-old male presented with abdominal pain, distension, and oliguria.
  • Physical examination revealed a distended abdomen with peritoneal signs.
  • Computed tomography showed small bowel distension, intramural gas, and fluid in the right lower quadrant, suggesting ischemia.

Findings:

  • Preoperative blood cultures identified Bacteroides fragilis.
  • Emergency laparotomy revealed a perforated, gangrenous appendix with abscess but no bowel infarction.
  • Appendectomy was performed, leading to an uneventful recovery.

Implications:

  • Pneumatosis intestinalis in the context of appendicitis may not invariably indicate a poor prognosis or bowel infarction.
  • The severity of the underlying condition, such as appendicitis, is a critical factor in determining the significance of PI.
  • This case underscores the need for careful evaluation of PI, considering the specific clinical context and underlying pathology.

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