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Pneumatosis cystoides intestinalis with colonic perforation: A case report and literature review
Jihua Cao1, Daigui Zi2, Min Chen2
1Department of Hepatobiliary Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang City, China.
Rationale:
Pneumatosis cystoides intestinalis (PCI) is an uncommon complaint that can produce free gas below the diaphragm, mimicking gastrointestinal perforation, which can easily lead to misdiagnosis. Although prognosis is generally good in most cases, complications can pose a threat to life and may require surgical intervention. Currently, clear surgical guidelines for PCI complicated by colonic perforation are lacking.
Patient Concerns And Diagnoses:
We present the case of a 57-year-old male patient with pneumatosis cystoides intestinalis complicated by colonic perforation. The patient was admitted because of persistent upper abdominal pain for 3 days, which worsened over 5 hours. The client suffered from a history of chronic obstructive pulmonary disease, pulmonary bullae, and heart failure.
Interventions And Outcomes:
Emergency surgery was performed, during which severe abdominal contamination, significant colon dilation, cystic bubbles in the intestinal wall, and perforation of the splenic flexure of the transverse colon were observed. Consequently, the doctors performed partial colectomy and colostomy. Postoperatively, due to recurrent fever symptoms, he was transferred to a higher-level hospital for further treatment and was ultimately discharged successfully.
Lessons:
PCI combined with colonic perforation should be regarded as a routine differential diagnosis for urgent abdominal pain. Although conservative treatment is the preferred option in most cases, timely surgical intervention should be considered in the presence of complications, hemodynamic instability, signs of peritonitis, and significant abnormal laboratory and imaging findings. Based on the current evidence, partial colectomy with colostomy is recommended for patients undergoing PCI combined with colonic perforation.
Insights
Pneumatosis cystoides intestinalis (PCI) with colonic perforation requires prompt diagnosis. Surgical intervention, including partial colectomy and colostomy, is recommended for complicated cases, offering a successful outcome.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Abdominal Imaging
Background:
- Pneumatosis cystoides intestinalis (PCI) is a rare condition that can mimic gastrointestinal perforation, leading to misdiagnosis.
- While often benign, PCI complications, such as colonic perforation, can be life-threatening and necessitate surgical intervention.
- Current surgical guidelines for PCI with colonic perforation are limited.
Purpose of the Study:
- To present a case of pneumatosis cystoides intestinalis complicated by colonic perforation.
- To discuss the diagnostic and management challenges associated with this rare condition.
- To highlight the importance of considering PCI in the differential diagnosis of acute abdominal pain.
Main Methods:
- A case report of a 57-year-old male with a history of COPD, pulmonary bullae, and heart failure presenting with severe abdominal pain.
- The patient was diagnosed with pneumatosis cystoides intestinalis complicated by colonic perforation.
- Emergency surgery involving partial colectomy and colostomy was performed.
Main Results:
- Surgical findings included severe abdominal contamination, colon dilation, intestinal cystic bubbles, and transverse colon perforation.
- The patient experienced postoperative fever but was successfully treated and discharged.
- This case underscores the need for timely surgical intervention in complicated PCI.
Conclusions:
- Pneumatosis cystoides intestinalis with colonic perforation should be a routine differential diagnosis for acute abdominal pain.
- Surgical intervention is crucial in cases with complications, hemodynamic instability, peritonitis, or significant abnormal findings.
- Partial colectomy with colostomy is a recommended surgical approach for PCI complicated by colonic perforation.
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