Case of pneumatosis intestinalis, manifesting as small bowel obstruction

Pneumatosis Intestinalis
Gross pneumatosis of the small bowel identified at the time of laparotomy.

Pneumatosis intestinalis in 88-year-old with complaints of abdominal pain and vomiting

This article describes the case of an 88-year-old who presented with complaints of severe abdominal pain and vomiting. Doctors advised a chest x-ray which showed free intraperitoneal air. The findings were also consistent with small bowel obstruction. For further investigation a CT scan was advised which showed free intraperitoneal gas. Based on these findings, doctors diagnosed the patient with pneumatosis intestinalis.

Pneumatosis is the presence of gas in the bowel wall, which is often identified through abdominal radiographs or computed tomography (CT) scans. The cause of the condition range from benign to fulminant. It is often seen to be associated with ischemia, especially in case of portomesentlric venous gas. It is also often seen in other conditions, for example, AIDS, amyloidosis, leukemia, celiac disease, infectious enteritis, connective tissue disorders and chronic obstructive pulmonary disease. The diagnosis of PI in neonates is associated with necrotising enterocolitis and has a high mortality rate.

The condition was initially described by Du Vernoi in 1783

Since then, it has been referred to with multiple pseudonyms. In addition, the incidence of the condition has increased since the use of CT for intraabdominal pathology. It is also believed that the incidence may have increased because of iatrogenic causes, including the instrumentation of the gastrointestinal tract and prescribed medications.

Surgical intervention may be required in patients with acute abdomen, ischaemic bowel and evidence of obstruction. PI is commonly identified on routine radiographs of the abdomen. During endoscopy, submucosal cysts may also be identified occasionally. The cysts may appear similar to polyps. The polyps can be examined at biopsy for identifying signs of inflammation. The gas is usually seen collecting peripherally in the lumen of the bowel and around contrast or fecal material. This gas can trigger pneumatosis which is visible on CT scans.

Source: BMJ

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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