Case report: recognizing pneumatosis intestinalis: a case of bowel ischemia presenting as renal colic

Abstract

The clinical diagnosis of bowel ischemia is often difficult and the diagnosis can easily be missed unless there is a high index of clinical and radiological suspicion. Bowel ischemia and or infarction must be considered in the differential diagnosis in the older patient with pre-existing coronary artery or generalized vascular disease, cardiac failure, or arrhythmias especially atrial fibrillation and hypertension. An elderly patient with caecal infarction is presented who was initially diagnosed and treated for renal colic.

Figure 1

Supine abdomen demonstrates extensive pelvic vascular calcification. However no radio-opaque calculi are present. The bowel gas pattern was initially considered to be normal, but closer inspection demonstrates pneumatosis intestinalis within the cecal wall (arrow).

Figure 2

(a) Noncontrast CT image of the liver demonstrates intraluminal gas in a portal venule in the caudate lobe (arrow). (b) Noncontrast CT image through the lower abdomen demonstrates cecal wall thickening with fat stranding and linear pneumatosis intestinal within the cecal wall with intraluminal gas in adjacent mesenteric venules (arrows). Note the calcified mesenteric artery branches.