Unique Case of Gastroenteritis Presenting as Pneumatosis Intestinalis With Emphysematous Gastritis and Portal Vein Gas: Do Not Take Gastroenteritis Lightly.

Asif Mehmood,Rajesh Essrani,Swetha Parvataneni,Umair Iqbal

doi:10.7759/cureus.8765

Abstract

Pneumatosis intestinalis (PI) consists of multiple, thin, gas-filled cysts in the wall of the gastrointestinal (GI) tract. It is an uncommon entity that can involve any gastrointestinal site from the stomach to the rectum. Isolated stomach involvement is rare. PI can represent a broad spectrum of diseases with variable prognoses. We present the case of a patient who was admitted with gastroenteritis-like symptoms. He remained hemodynamically stable, and on further imaging with contrast-enhanced computed tomography of the abdomen and pelvis, air was found in the portal vein and gastric wall, with minimal thickening of the proximal small bowel concerning for emphysematous gastroenteritis. Further workup results were negative, including blood cultures, stool studies, Clostridium difficile toxins, and lactic acid levels. The patient was managed nonoperatively and recovered without serious complications. Our case is unique in terms of the presence of air in the portal vein, which would otherwise suggest the possible spread of infection across the bowel wall.

Highlights

Pneumatosis intestinalis (PI) refers to the presence of multiple, thin, gas-filled cysts in the wall of the gastrointestinal (GI) tract
An 87-year-old man presented with multiple episodes of non-bloody, watery diarrhea associated with nausea and epigastric pain for two days
Further workup results were negative, including blood cultures, stool studies, Clostridium difficile toxins, and lactic acid levels. He was admitted to the intensive care unit (ICU) for closer monitoring and evaluated by surgery, gastroenterology, and infectious disease specialists

Summary

Introduction

Pneumatosis intestinalis (PI) refers to the presence of multiple, thin, gas-filled cysts in the wall of the gastrointestinal (GI) tract It is a rare condition made evident by the increased use of radiographic imaging and can involve any site along the gastrointestinal tract. Secondary PI is associated with numerous gastrointestinal conditions like intestinal obstruction, ischemic bowel disease, and necrotizing enterocolitis in premature infants. An 87-year-old man presented with multiple episodes of non-bloody, watery diarrhea associated with nausea and epigastric pain for two days He had a past medical history of hypertension, hyperlipidemia, and coronary artery disease with bypass surgery. Further workup results were negative, including blood cultures, stool studies, Clostridium difficile toxins, and lactic acid levels He was admitted to the intensive care unit (ICU) for closer monitoring and evaluated by surgery, gastroenterology, and infectious disease specialists. The patient recovered well with nonoperative management and was discharged on oral antibiotics after a few days, with plans to follow up with outpatient CT scan imaging

Discussion

Conclusions

Disclosures

Koss LG

14. Florin TH