Pneumatosis intestinalis with pneumoperitoneum misdiagnosed as acute abdomen - a case report

Abstract

Background: Pneumatosis intestinalis (PI), is defined as the presence of intramural gas within the bowel wall. Pneumatosis intestinalis is not a diagnosis. It is more a histological finding or a radiology sign, rather than a disease on itself. In most of the cases it is a benign finding, but it may be a reason for an unnecessary laparotomy, especially when associated with pneumoperitoneum. Case report: We present a case of pneumatosis intestinalis in a patient with a chronic obstructive pulmonary disease misdiagnosed as intestinal perforation due to bowel ischemia. The patient was admitted with increasing abdominal pain and nausea. On examination the abdomen was tender with diffuse pain. Plain X-rays and CT scans showed pneumoperitoneum with intramural gas in small intestine’s wall. With preoperative diagnosis of bowel ischemia the patient underwent exploratory laparotomy, on which a benign PI was found. Conclusion: Carefully taken medical history, prompt exam, laboratory and instrumental data all should be carefully analyzed before a decision for emergency operation is done. It is important to divide PI in two categories- benign and life-threating.