Does massive intraabdominal free gas require surgical intervention?
We describe a rare case of an 81-year-old man who presented with severe epigastralgia. A chest radiograph showed massive free gas bilaterally in the diaphragmatic spaces. Computed tomography (CT) scan also showed massive free gas in the peritoneal cavity with portal venous gas. We used a wait-and-see approach and carefully considered surgery again when the time was appropriate. The patient received conservative therapy with fasting, an intravenous infusion of antibiotics, and nasogastric intubation. The patient soon recovered and was able to start eating meals 4 d after treatment; thus, surgical intervention was avoided. Thereafter, colonoscopy examination showed pneumatosis cystoides intestinalis in the ascending colon. On retrospective review, CT scan demonstrated sporadic air-filled cysts in the ascending colon. The present case taught us a lesson: the presence of massive intraabdominal free gas with portal venous gas does not necessarily require surgical intervention. Pneumatosis cystoides intestinalis should be considered as a potential causative factor of free gas with portal venous gas when making the differential diagnosis.
Tadashi Furihata, Makoto Furihata, Kunibumi Ishikawa, Masato Kosaka, Naoki Satoh, Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki 309-1195, Japan.
Tadashi
T
Furihata
Tadashi Furihata, Makoto Furihata, Kunibumi Ishikawa, Masato Kosaka, Naoki Satoh, Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki 309-1195, Japan.
Makoto
M
Furihata
Tadashi Furihata, Makoto Furihata, Kunibumi Ishikawa, Masato Kosaka, Naoki Satoh, Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki 309-1195, Japan.
Kunibumi
K
Ishikawa
Tadashi Furihata, Makoto Furihata, Kunibumi Ishikawa, Masato Kosaka, Naoki Satoh, Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki 309-1195, Japan.
Masato
M
Kosaka
Tadashi Furihata, Makoto Furihata, Kunibumi Ishikawa, Masato Kosaka, Naoki Satoh, Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki 309-1195, Japan.
Naoki
N
Satoh
Tadashi Furihata, Makoto Furihata, Kunibumi Ishikawa, Masato Kosaka, Naoki Satoh, Department of General Surgery, Kyouwa Chuo Hospital, Chikusei-shi, Ibaraki 309-1195, Japan.
Keiichi
K
Kubota
D000369:Aged, 80 and over; D003113:Colonoscopy; D000072700:Conservative Treatment / Q000379:methods; D006801:Humans; D008297:Male; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014057:Tomography, X-Ray Computed
Case reports; Colonoscopy; General surgery; Pneumatosis cystoides intestinalis; Portal vein