Intestinal Research

Case Report

A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis: Chetan Rathi, Nirav Pipaliya, Prateik Poddar, Vikas Pandey, Meghraj Ingle, Prabha Sawant; Intest Res 2015;13(4):346-349. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.346

Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.

Citations

Citations to this article as recorded by

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Case Report: An unusual case of small bowel volvulus due to appendicitis associated with pneumatosis intestinalis: Review of the literature
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F1000Research.2021; 10: 951. CrossRef
Gastric Outlet Obstruction and Sigmoid Volvulus in a Patient with Pneumatosis intestinalis: An Etiology or a Complication
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Original Article

Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy: Won Young Park, Tae Hee Lee, Joon Seong Lee, Su Jin Hong, Seong Ran Jeon, Hyun Gun Kim, Joo Young Cho, Jin Oh Kim, Jun Hyung Cho, Sang Wook Lee, Young Kwan Cho; Intest Res 2015;13(4):313-317. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.313

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG.

Methods

We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion.

Results

Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock.

Conclusions

The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.

Citations

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Jahnvi Dhar, Naveen Kumar, Pankaj Gupta, Rakesh Kochhar, Jayanta Samanta
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Tim Brotherton, Anuj Chhaparia, Michael Presti, Gregory Sayuk, Jill Elwing
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7,702 View
59 Download
16 Web of Science
16 Crossref

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