Pneumatosis Cystoides Intestinalis: A Benign Cause of Pneumoperitoneum

Abstract

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition where cyst-like locules of gas are present in the submucosa or subserosa of the gastrointestinal tract. The majority of cases are benign and are associated with drugs such as chemotherapy agents or conditions including chronic obstructive airways disease. We present the case of PCI resulting in pneumoperitoneum in a 72-year-old male patient on chemotherapy for esophageal adenocarcinoma. While he was noted to have an extensive pneumoperitoneum and mesenteric emphysema on imaging, he remained clinically stable with a benign abdominal examination and was managed conservatively with intravenous antibiotics and fluids. This case highlights the importance of benign PCI as a differential to bowel ischemia in patients with pneumatosis intestinalis and pneumoperitoneum, particularly given the possibility of avoiding operative management and the resultant morbidity.

Keywords: Chemotherapy; Pneumatosis cystoides intestinalis; Pneumatosis intestinalis; Pneumoperitoneum.

Figure 1

Contrast-enhanced CT of abdomen and pelvis: (a) coronal view in soft tissue window, (b) axial view in soft tissue window, (c) axial view in lung window, showing intramural locules of gas within the right sided colon (arrow) and extensive gas within the mesocolon and mesentery (arrowhead) and pneumoperitoneum outlining the liver margin. CT: computed tomography.