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[Intestinal pneumatosis]
A T Calderón Duque1, J Mayol Martínez, J Martínez-Sarmiento
1Servicio de Cirugía General y del Aparato Digestivo I, Hospital Clínico Universitario San Carlos, Madrid.
Abstract:
Intestinal pneumatosis is an infrequent disease of difficult clinical and radiologic diagnosis. It may be accompanied by pneumoperitoneum in up to 30% of the cases leading to differential diagnosis with pictures of visceral perforation. We herein present 4 cases of intestinal pneumatosis in whom pneumoperitoneum was associated in 3 patients. Diagnosis was intraoperative in 2 patients submitted to emergency surgery because of an associated acute gastrointestinal event (intestinal volvulus and acute cholecystitis). The other 2 cases were diagnosed by computerized tomography and colonoscopy, respectively, and given their satisfactory clinical evolution they received conservative treatment. The course of the disease was favorable in all the patients with the radiologic signs of pneumatosis disappearing.
Insights
Intestinal pneumatosis, a rare condition, can mimic visceral perforation when accompanied by pneumoperitoneum. This study highlights diagnostic challenges and favorable outcomes with timely intervention or conservative management.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Pathology
Background:
- Intestinal pneumatosis is a rare condition that presents diagnostic challenges.
- It can be mistaken for visceral perforation, especially when pneumoperitoneum is present.
Observation:
- This study presents four cases of intestinal pneumatosis.
- Three of these cases were associated with pneumoperitoneum.
- Diagnosis was achieved intraoperatively in two patients with acute gastrointestinal events and via CT scan and colonoscopy in two others.
Findings:
- Two patients required emergency surgery for associated conditions like intestinal volvulus and acute cholecystitis.
- Two patients were managed conservatively after diagnosis via CT and colonoscopy.
- All patients experienced favorable outcomes with resolution of radiographic signs.
Implications:
- Accurate diagnosis of intestinal pneumatosis is crucial for appropriate management.
- Conservative treatment can be effective in select cases.
- Prompt surgical intervention is necessary for associated acute gastrointestinal emergencies.