Pneumatosis cystoides intestinalis: an unusual cause of intestinal ischemia and pneumoperitoneum

Abstract

Pneumatosis cystoides intestinalis (PCI), with an unknown etiology, is an uncommon disease characterized by the presence of multiple gas-filled cysts within the submucosa or subserosa of the intestinal wall. Intestinal obstruction and/or perforation are relatively uncommon complications associated with PCI. The patients are often prone to misdiagnosis or mistreatment. The diagnosis of PCI is based on plain radiography or endoscopy. Multidetector computed tomography (MDCT) provides data on other intra-abdominal pathologies. Therefore, it is an important modality for the diagnosis of PCI. We present a case of PCI in a 58-year-old man affected by peritoneal free air with multidetector computed tomography imaging findings. We performed the plain film of the abdomen, and MDCT studies that showed numerous, diffuse, bubble-like intramural gas collections into the jejunum, ileum, and colon walls at the left-upper quadrant of the abdomen. MDCT findings were confirmed by surgical exploration.

Keywords: Imaging; Intestinal ischemia; Pneumatosis cystoides intestinalis; Pneumoperitoneum.

Fig. 1

Plain film of the abdomen shows extensive cystic gas collections (black arrows), multiple air-fluid levels, and subdiafragmatic free intraperitoneal airs (white arrows).

Fig. 2

Virtual endoscopic view (A) and axial contrast-enhanced MDCT scan (B) show the presence of numerous gas collections (arrows) within the wall of the small bowel.

Fig. 3

The surgical exploration shows the characteristic features of pneumatosis cystoides intestinalis: air-filled cysts of various sizes in the subserosa of the small bowel.

Fig. 4

Surgical specimen reveals necrosis and marked ischemia in the intestine.