Case of Acute abdomen with gastric volvulus due to pneumatosis cystoides intestinalis: A report

Pneumatosis intestinalis is the abnormal presence of free air in many forms outside the lumen of the intestines. Classified as primary or secondary according to its etiology, it affects infants as well as adults and can affect any part of the GI tract.

Pneumatosis intestinalis can be classified as primary or secondary, but both represent the underlying pathology. The pathophysiology and etiology depend on the underlying conditions and prompt diagnosis is crucial in determining the treatment regimen. This activity reviews the evaluation and management of pneumatosis intestinalis and highlights the importance of an interprofessional team in the management of patients with this condition.

Researchers report a 55-year-old male patient with a past medical history of surgically repaired perforated duodenal ulcer, presenting with acute abdominal pain, bloating, and constipation. In the abdominal examination; Severe distention, tenderness and tympanicity were recorded on percussion. An erect CXR was performed and showed bilateral subdiaphragmatic air levels. We performed an abdominal Paracentesis which caused a large volume of air to be evacuated below the right subcostal margin. Subsequently, an exploratory laparotomy showed that the cause was a gastric volvulus associated with anterior and posterior gastric wall ruptures. Appropriate surgical repair approach was applied, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) has spread along the great length of the intestines in many forms and without any symptoms or signs.

Thus, the researchers concluded that pneumatosis cystoides intestinalis has usually been reported in relation to peptic ulcer disease (PUD). In the instant case they have reported a new association of gastric volvulus and pneumatosis cystoides intestinalis secondary to pyloric stenosis caused by duodenal ulcer; They believe it can help diagnose dangerous complications of a rare disease.

Reference:

Chihab, M., Qadabashi, K., Abbas, H. et al. Acute abdomen with gastric volvulus revealing an underlying pneumatosis cystoides intestinalis: a case report. BMC Surg 22, 267 (2022). https://doi.org/10.1186/s12893-022-01717-6