title: A case of pneumoperitoneum and retropneumoperitoneum without bowel perforation due to extensive intestinal necrosis as a complication to chemotherapy: CT evaluation.
abstract: Acute intestinal ischemia continues to be a challenging diagnostic problem with high mortality. We describe a rare case of acute intestinal necrosis, due to vasculitis, related with chemotherapy. A patient was examined in our emergency department, presenting with abdominal pain. Three months before he had undergone an operation for lung carcinoma (lobectomy) and received chemotherapy. CT of the abdomen demonstrated free air in 10 different locations: hepatic part of the portal vein, branches of mesenteric veins, femoral and iliac veins, the bowel wall, peritoneal cavity and retroperitoneal space, abdominal muscles, inguinal canals, meso-sigmoid space, and in the para-rectal space. Moreover, pathological findings revealed that the free air in the peritoneum and retropneumoperitoneum occurred without intestinal perforation, but with transudation through the necrotic bowel wall. This is a rare complication of chemotherapy. This case refers to the unusual CT findings which appeared in this patient. The key to a better outcome is early diagnosis of this condition and the CT examination of the abdomen plays an important role.
authors.affiliation: Department of Computed and Magnetic Tomography, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Antonopoulos
authors.affiliation: 1st Surgery Department, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Siaperas
authors.affiliation: Department of Computed and Magnetic Tomography, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Troumboukis
authors.affiliation: Department of Pathology, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Demonakou
authors.affiliation: 1st Surgery Department, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Alexiou
authors.affiliation: 1st Surgery Department, Sismanoglio General Hospital, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Economou
keywords: CT; Pneumoperitoneum; chemotherapy; intestinal; ischemia; necrosis