Pneumatosis intestinalis: a rare manifestation of acute appendicitis.
Pneumatosis intestinalis (PI), the presence of gas within the bowel wall, is a rare condition. To our knowledge, only two cases of PI secondary to acute appendicitis have been reported in the literature. We present a new case of a 46-year-old man who complained of abdominal pain and progressive abdominal distension for 4 days and oliguria for 1 day. In the Emergency Department, his abdomen was markedly distended and showed peritoneal signs. Preoperative blood culture grew Bacteroides fragilis. Abdominal computed tomography scan revealed marked bowel distension, bubble-like intramural gas scattered in the proximal small bowel, and localized fluid accumulation in the right lower quadrant of the abdomen. Small bowel ischemia was interpreted preoperatively. Emergency laparotomy revealed that the appendix was gangrenous and perforated, with local abscess formation but no bowel infarction. Hence, only appendectomy was performed, with subsequent uneventful patient recovery. The presence of PI may not always be an ominous sign; rather, it depends on the severity of any underlying diseases.
Pai
Hung-Jia
HJ
Department of General Surgery, Chang Gung Memorial Hospital, Chia-yi, Chang Gung Institute of Technology, Chang Gung University, Chiayi, Taiwan.
Wang
Chia-Siu
CS
Hsieh
Ching-Chuan
CC
Wang
Wen-Ke
WK
Yang
Bor-Yau
BY
D000006:Abdomen, Acute / Q000209:etiology; D018784:Abdominal Abscess / Q000209:etiology; D001064:Appendicitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005734:Gangrene; D006801:Humans; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed