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Pseudopneumoperitoneum in chronic intestinal pseudo-obstruction: a case report
Luigi Camera1, Milena Calabrese, Giovanni Sarnelli
1Department of Bio-morphological and Functional Sciences, University Federico II, 80131 Naples, Italy. camera@unina.it
World Journal of Gastroenterology
|July 8, 2011
Summary
Chronic intestinal pseudo-obstruction (CIPO) can mimic mechanical obstruction on imaging. This case highlights how radiological signs suggesting pneumoperitoneum were false positives in a patient with CIPO.
Area of Science:
- Gastroenterology
- Radiology
- Internal Medicine
Background:
- Chronic intestinal pseudo-obstruction (CIPO) is a rare gastrointestinal motility disorder.
- CIPO can clinically and radiologically mimic mechanical bowel obstruction.
Observation:
- A 26-year-old woman presented with constipation, abdominal pain, and distension.
- Plain abdominal X-rays showed signs suggestive of pneumoperitoneum, including subphrenic radiolucency and air-fluid levels.
- The patient had no peritoneal signs, only hypoactive bowel sounds.
Findings:
- Unenhanced multi-detector computed tomography (MDCT) revealed abnormal air-driven distension of the small and large bowel.
- No extra-luminal air was detected, indicating the pneumoperitoneum signs were false positives.
- Further investigations including pan-colonoscopy and anorectal manometry ruled out Hirshprung's disease.
Implications:
- This case underscores the importance of correlating imaging findings with clinical presentation in diagnosing CIPO.
- Radiological signs mimicking pneumoperitoneum can occur in CIPO, necessitating advanced imaging for accurate diagnosis.
- Distinguishing CIPO from mechanical obstruction is crucial for appropriate patient management and treatment.
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