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Pneumatosis intestinalis presenting with acute abdomen
Cameron Fleming1, Conor Joseph Hardacre2,3, Ayaz Memon2
1Department of Colorectal Surgery, Royal Liverpool University Hospital, Liverpool, England, UK cafleming@doctors.net.uk.
BMJ Case Reports
|July 25, 2025
Summary
A woman presented with severe abdominal pain and bradycardia. Imaging revealed pneumoperitoneum and bowel obstruction, leading to laparotomy where pneumatosis intestinalis was diagnosed.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Radiology
Background:
- Pneumatosis intestinalis, characterized by gas in the bowel wall, can present with acute abdominal symptoms.
- Distinguishing benign from malignant causes of pneumatosis intestinalis is crucial for patient management.
- This case highlights a rare presentation of pneumatosis intestinalis mimicking bowel obstruction.
Purpose of the Study:
- To report a case of pneumatosis intestinalis presenting as acute abdominal pain and bowel obstruction.
- To discuss the diagnostic challenges and management of this condition.
Main Methods:
- A case study of a woman in her 70s presenting with acute abdominal symptoms.
- Diagnostic workup included computed tomography (CT) scan.
- Surgical exploration via emergency laparotomy was performed.
Main Results:
- CT scan revealed pneumoperitoneum and findings suggestive of volvulus and bowel obstruction.
- Emergency laparotomy identified extensive small gas-filled blisters in the submucosa of the mid-small bowel, consistent with pneumatosis intestinalis.
- Adhesiolysis was performed, and no alternative pathology was found.
Conclusions:
- Pneumatosis intestinalis can present acutely with symptoms mimicking bowel obstruction.
- While often benign, thorough investigation is necessary to rule out other pathologies.
- Surgical intervention may be required for diagnosis and management.
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