Incidental pneumoperitoneum due to pneumatosis intestinalis: A rare case of benign pneumoperitoneum

• Published in: International journal of surgery case reports 2024-03, Vol.116, p.109363, Article 109363
• Main Authors: Atri, Souhaib, Hammami, Mahdi, Sebai, Amine, Zaiem, Aida, Laabidi, Sarra, Kacem, Montassar
• Format: Article
• Language: English
• Subjects: Case report; Diagnosis; Pneumatosis intestinalis; Pneumoperitoneum
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109363

Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a rare but significant gastrointestinal condition. It may be associated with underlying gastrointestinal disorders or detected incidentally, posing diagnostic challenges. This article emphasizes the importance of recognizing and managing this condition conservatively when appropriate. A previously healthy 40-year-old Caucasian female patient presented with left lumbar fossa pain, initially suggestive of renal colic. Physical examination revealed stable vital signs and a soft abdomen. Laboratory tests showed no signs of inflammation or renal abnormalities. Abdominal CT scan ruled out urinary lithiasis but identified pericolonic pneumoperitoneum on the left side. Due to the absence of peritonitis signs, surgical intervention was deferred. Over 72 h of close monitoring, the patient remained stable without clinical deterioration. Subsequent CT scans confirmed pneumatosis intestinalis. The patient remained asymptomatic and underwent a confirming colonoscopy. Pneumatosis intestinalis can manifest with varying severity and is often linked to underlying gastrointestinal conditions. It can mimic life-threatening conditions like bowel perforation, necessitating careful differentiation. Non-surgical pneumoperitoneum, exemplified in this case, may result from benign causes like PI, warranting meticulous evaluation to prevent unnecessary surgery. This case highlights the need to recognize and manage asymptomatic PI. A multidisciplinary approach and CT imaging play pivotal roles in ensuring optimal patient outcomes. Vigilance among healthcare professionals is essential to consider PI in asymptomatic patients, mitigating the risk of undue surgical interventions, and facilitating timely diagnosis and intervention when necessary. •Pneumatosis intestinalis (PI) is a condition with a 0.3% incidence, characterized by gas in the bowel wall and varying degrees of severity.•PI poses diagnostic challenges as it can mimic bowel perforation, causing confusion in cases of uncertain septic shock origin, and distinguishing between surgical and non-surgical pneumoperitoneum is crucial for proper management.•PI is defined by gas-filled cystic spaces in the intestinal wall, and its enigmatic nature is evident in cases where no clear association with underlying gastrointestinal issues is apparent.•CT imaging plays a pivotal role in diagnosing PI by providing detailed visualization of gas within the intestina