Capone O, D'Alò G L, Aniballi M, Pletto S, Villa M, De Majo A, Venditti D, Grande Maurizio
G Chir. 2018 Nov-Dec;39(6):391-394.
Pneumatosis intestinalis (PI) is described as the presence of air within bowel wall. PI aetiology is various: it can be associated with non-urgent or life-threatening conditions. Clinical management is based on physical examination, blood tests and radiology, in particular abdominal CT. The cause of PI suggests the correct therapy. When PI is linked to gas in portal and mesenteric venae (PMVG), bowel ischemia or infarction is possible, and surgery needed.
A 91 years-old man was admitted to Emergency Department reporting abdominal pain and vomit. Acute abdominal symptoms, radiological finding of small bowel PI with massive PMVG, severe neutrophilia, and high serum lactate forced us to perform exploratory laparotomy, from which it was observed a diffuse band-like pneumatosis of all the small bowel and mesentery without ischemic or peritonitis signs. The patient was imposed to fast and treated with oxygen, intravenous fluid and antibiotic therapy, without performing further surgery, and was discharged to a rehabilitation facility after symptomatology resolution.
Scientific literature underlines the importance of PMVG to consider as critic a patient with PI, but it is always essential to assess also physical examination, vital parameters, and blood exams. In our case, several signs were suggestive for bowel infarction: its absence and the swift recovery of the patient were unexpected.
Although non-surgical treatment is recommended for primary PI of unknown aetiology, in case physical examination and radiological signs aren't decisive surgery is necessary to rule out bowel infarction. This case stresses the difficulty of PI management.
肠壁积气（PI）是指肠壁内存在气体。PI的病因多种多样：它可能与非紧急或危及生命的情况相关。临床管理基于体格检查、血液检查和放射学检查，特别是腹部CT。PI的病因提示正确的治疗方法。当PI与门静脉和肠系膜静脉积气（PMVG）相关时，可能发生肠缺血或梗死，需要进行手术。
一名91岁男性因腹痛和呕吐入住急诊科。急性腹部症状、小肠PI伴大量PMVG的放射学表现、严重的中性粒细胞增多症和高血清乳酸水平迫使我们进行剖腹探查，术中观察到所有小肠和肠系膜弥漫性带状积气，无缺血或腹膜炎体征。患者被要求禁食，并接受吸氧、静脉补液和抗生素治疗，未进行进一步手术，症状缓解后出院至康复机构。
科学文献强调对于PI患者，将PMVG视为危急情况的重要性，但评估体格检查、生命体征和血液检查也始终至关重要。在我们的病例中，有几个迹象提示肠梗死：但未出现肠梗死且患者恢复迅速，这出乎意料。
尽管对于病因不明的原发性PI推荐非手术治疗，但如果体格检查和放射学体征不明确，则需要进行手术以排除肠梗死。本病例强调了PI管理的困难。
