Case Report
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Jun 27, 2011; 3(6): 86-88
Published online Jun 27, 2011. doi: 10.4240/wjgs.v3.i6.86
Pneumatosis intestinalis and pneumoperitoneum on computed tomography: Beware of non-therapeutic laparotomy
Kuan-Chun Hsueh, Shung-Sheng Tsou, Kok-Tong Tan
Kuan-Chun Hsueh, Shung-Sheng Tsou, Kok-Tong Tan, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung City 435, Taiwan, China
Author contributions: All authors wrote this case report.
Correspondence to: Kok-Tong Tan, MD, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, No. 699, Chung-Chi Rd, Sec 1, Wuchi District, Taichung City 435, Taiwan, China.
Telephone: +886-4-26581919-4300 Fax: +886-4-26582193
Received: July 13, 2010
Revised: March 14, 2011
Accepted: March 21, 2011
Published online: June 27, 2011

Pneumatosis intestinalis (PI) is defined as gas within the gastrointestinal wall and is associated with a variety of disorders. As a concurrent occurrence with pneumoperitoneum, it can easily to be mistaken for bowel ischemia with perforated peritonitis. In fact, air dissection or rupture from subserosal cysts may be the cause of intraperitoneal and intraluminal free air, with clinical symptoms such as abdominal pain and fullness occurring as a result. We hereby report a case of an 82-year-old male with a history of chronic obstructive pulmonary disease who was diagnosed with bowel ischemia and received emergency laparotomy because of the appearance of PI and pneumoperitoneum on abdominal computed tomography scan. However, no perforated hollow organ or necrotic bowel segment was found, only diffusely distributed massive intraperitoneal air and PI of gastrointestinal tract. The laparotomy seemed non-therapeutic for this patient. This is significant warning for clinicians to differentiate the associated conditions of PI, and to evaluate whether or not emergency surgery is necessary.

Keywords: Pneumatosis intestinalis, Pneumoperitoneum, Computed tomography