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. 2014;5(12):909-13.
doi: 10.1016/j.ijscr.2014.09.031. Epub 2014 Oct 16.

The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature

Mehmet Aziret  1 , Hasan Erdem  2 , Yiğit Ülgen  3 , Şahin Kahramanca  4 , Süleyman Çetinkünar  2 , Hilmi Bozkurt  2 , İlhan Bali  5 , Oktay İrkörücü  2
Affiliations

The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature

Mehmet Aziret et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression.

Presentation of case: Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest.

Discussion: PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery.

Conclusion: In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.

Keywords: Gas-filled cysts; Pneumatosis sistoides intestinalis; Terminal ileum.

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Figures

Fig. 1
Fig. 1
X-ray free air under the diaphragm.
Fig. 2
Fig. 2
Abdominal CT showed intraperitoneal free air.
Fig. 3
Fig. 3
Stenotic pylorus and dilated stomach.
Fig. 4
Fig. 4
Gas-filled cysts in the terminal ileum.
Fig. 5
Fig. 5
Gas-filled cysts at mucosa in the terminal ileum.
Fig. 6
Fig. 6
Histopathological appearances of gas-filled cyst. A) The Low-cubic cystic epithelium in serosa of ileum (white arrow, H&E ×100). (B) Gas-filled cysts in serosa cecum.
See this image and copyright information in PMC

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