Abstract
Pneumatosis cystoides intestinalis is a rare clinical phenomenon in which there is presence of gas filled cysts in the gut wall. Its exact cause is not known but this condition is commonly associated with smoking and other factors leading to raised intra-abdominal pressure. Sometimes these gasses filled cysts may rupture on their own or secondary to some surgical intervention leading to presence of free gas in the abdomen or retroperitoneum. We present here a case report of the patient who presented to the emergency room with pain abdomen and a large amount of free gas in the abdomen seen on erect X-ray of the abdomen. Here comes the challenge to the surgeon, whether to operate or not. Contrast Enhanced Computerised Tomography (CECT) scan of the abdomen is a better modality for diagnosing Pneumatosis cystoides intestinalis (PCI) and it can prevent unnecessary surgeries. However, the management of this condition is mainly nonsurgical, and oxygen forms the mainstay of therapy.
Highlights
Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, which is otherwise a harmless collection of air within the gut wall giving rise to multiple air-filled cysts, but when these cysts rupture they may produce pneumoperitoneum and complicate the clinical scenario
They usually have a history of chronic respiratory disorders like bronchitis and asthma, malabsorption syndrome, connective tissue disorders or intake of substrates which remain unabsorbed inside the gut like lactulose or sorbitol [1]
The patients commonly present with an underlying illness and it is only during the investigations that they are detected with PCI [6]
Summary
Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, which is otherwise a harmless collection of air within the gut wall giving rise to multiple air-filled cysts, but when these cysts rupture they may produce pneumoperitoneum and complicate the clinical scenario. The patients usually present to emergency room (ER) with some other ailments but the abdominal X-rays reveal free gas under diaphragm in about two thirds of the patients. They usually have a history of chronic respiratory disorders like bronchitis and asthma, malabsorption syndrome, connective tissue disorders or intake of substrates which remain unabsorbed inside the gut like lactulose or sorbitol [1]. PCI is not a premalignant condition, but it has been seen in association with carcinoma stomach, lymphosarcoma and widespread carcinomatosis of the abdomen [2] These patients showing pneumoperitoneum or pneumoretroperitoneum are a management dilemma. On the basis of history, clinical examination and erect X-ray abdomen showing free gas under diaphragm, the possibility of perforated duodenal ulcer was kept. The patient has recovered well and is still in follow up after six months
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