Pneumatosis Intestinalis Secondary to Appendicitis: What Do We Know?

Area of Science:

• Gastroenterology
• Surgical Pathology

Background:

• Pneumatosis intestinalis (PI), characterized by gas in the bowel wall, is an uncommon finding.
• Concomitant PI with acute appendicitis is exceptionally rare, with limited documented cases.
• Understanding this association is crucial for diagnosis and management.

Purpose of the Study:

• To present a unique case of pneumatosis intestinalis (PI) in a middle-aged patient with appendicitis.
• To conduct the first comprehensive literature review of all reported cases of PI associated with acute appendicitis.

Main Methods:

• A systematic literature search was performed across PubMed, ResearchGate, Google Scholar, and Medline.
• Keywords included "appendicitis," "appendix," "pneumatosis intestinalis," "gas," "bowel," "lumen," and "intramural."
• Inclusion criteria focused on cases of appendicitis with findings of PI in patients over 28 days old.

Main Results:

• The study identified 11 previously reported cases, adding the current case as the 12th.
• Middle-aged men with obesity, hypertension, and type II diabetes mellitus are identified as a vulnerable demographic.
• Computed tomography (CT) is highlighted as a key diagnostic tool for PI-associated appendicitis.

Conclusions:

• This study provides the first literature review of PI secondary to acute appendicitis.
• Patients with PI and appendicitis tend to be older, present later, and have poorer outcomes than typical appendicitis cases.
• These patients often require major abdominal surgery and experience longer hospital stays.