Ribolla Marta, Conti Luigi, Baldini Edoardo, Palmieri Gerardo, Grassi Carmine, Banchini Filippo, Dacco' Maria Diletta, Capelli Patrizio
Department of Medicine and Surgery, AOU Parma, Via Gramsci 14, Parma, Italy.
Department of Surgery, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy.
Int J Surg Case Rep. 2020;69:92-95. doi: 10.1016/j.ijscr.2020.03.042. Epub 2020 Apr 1.
Pneumatosis cystoides intestinalis (PCI) is a rare clinical pathology characterized by sub-mucosal and/or sub-serous cysts of free gas, forming cystic lesions usually ranging from 0.5 to 2.0 cm in size within the gastrointestinal tract. About 3% of patients with PCI develop complications such as pneumoperitoneum, intestinal volvulus, obstruction, or hemorrhage, these cases need immediate surgical intervention. Cyst rupture can produce peritoneal irritation and pneumoperitoneum.
A 65-years-old woman was admitted to the Emergency Department for epileptiform convulsions. Her medical hystory included epilepsy, diabetes, lichenoid dermatitis, hypothyroidism, severe cognitive impairment. Abdominal CT scan revealed a dilated large intestine with parietal pneumatosis from the appendix to the transverse colon associated to extensive pneumoperitoneum. The patient underwent emergency laparotomy which revealed the presence of gas within the wall of right and transverse colon and distension of great omentum. No resection was needed as normal blood supply to the bowel present.
Pneumatosis coli can be both asymptomatic or life-threatening condition associated to bowel infarction; this situation can mimic a bowel perforation causing pneumoperitoneum - that sometimes is a non-surgical pneumoperitoneum - and it could be a misleading indication to surgical exploration especially in the case of uncertain origin of a septic shock.
We report a case of pneuomoperitoneum due to PCI. Surgical intervention was required for patient's conditions and unclear origin of the sepsis.
肠壁囊样积气症（PCI）是一种罕见的临床病理状态，其特征为黏膜下和/或浆膜下出现游离气体囊肿，在胃肠道内形成通常大小为0.5至2.0厘米的囊性病变。约3%的PCI患者会出现诸如气腹、肠扭转、肠梗阻或出血等并发症，这些病例需要立即进行手术干预。囊肿破裂可导致腹膜刺激和气腹。
一名65岁女性因癫痫样惊厥被收入急诊科。她的病史包括癫痫、糖尿病、苔藓样皮炎、甲状腺功能减退、严重认知障碍。腹部CT扫描显示大肠扩张，从阑尾至横结肠有肠壁积气，并伴有广泛气腹。患者接受了急诊剖腹手术，术中发现右半结肠和横结肠肠壁内有气体，大网膜肿胀。由于肠道血供正常，无需进行切除。
结肠积气症既可以是无症状的，也可能是与肠梗死相关的危及生命的状况；这种情况可能类似肠穿孔导致气腹——有时是一种非手术性气腹——这可能会误导手术探查，尤其是在脓毒症休克病因不明的情况下。
我们报告了一例因PCI导致气腹的病例。鉴于患者的病情以及脓毒症病因不明，需要进行手术干预。
