Karoui Yasser, Kebir Ghassen Hamdi, Mazlout Majed, El Heni Sirine, Maatouk Mohamed, Moussa Mounir Ben
Department of Surgery A, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia.
Department of Surgery A, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007 Tunis, Tunisia.
Int J Surg Case Rep. 2025 Aug 20;135:111848. doi: 10.1016/j.ijscr.2025.111848.
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the intestines. We report a case in which PCI with pneumoperitoneum was incidentally discovered following trauma, revealing an underlying stenosing pyloro-duodenal ulcer.
A 60-year-old man was admitted after a road traffic accident. Computed tomography revealed significant pneumoperitoneum without signs of organ injury. Emergency laparotomy showed extensive PCI involving the small bowel, without any perforation. Postoperative esophagogastroduodenoscopy confirmed a markedly dilated stomach and a completely stenosing duodenal ulcer. The patient subsequently underwent antrectomy with gastrojejunostomy and bilateral vagotomy. The postoperative course was uneventful, and histopathology showed no malignancy.
PCI may mimic surgical emergencies such as gastrointestinal perforation. In this patient, trauma revealed both PCI and a previously undiagnosed gastric outlet obstruction. The literature supports conservative management in uncomplicated PCI, reserving surgery for complications or when life-threatening conditions cannot be excluded.
This case highlights the diagnostic challenge of PCI in trauma. Pneumoperitoneum does not always indicate perforation. A comprehensive diagnostic approach is essential to avoid unnecessary resections and to identify underlying conditions such as peptic ulcer disease.
肠壁囊样积气症（PCI）是一种罕见病症，其特征为肠道壁内存在气体囊肿。我们报告一例在创伤后偶然发现伴有气腹的PCI病例，该病例揭示了潜在的幽门十二指肠狭窄性溃疡。
一名60岁男性在道路交通事故后入院。计算机断层扫描显示有明显气腹，但无器官损伤迹象。急诊剖腹探查显示广泛的PCI累及小肠，无任何穿孔。术后食管胃十二指肠镜检查证实胃明显扩张且十二指肠溃疡完全狭窄。患者随后接受了胃窦切除术、胃空肠吻合术和双侧迷走神经切断术。术后过程顺利，组织病理学检查未发现恶性肿瘤。
PCI可能类似胃肠道穿孔等外科急症。在该患者中，创伤揭示了PCI和先前未诊断出的胃出口梗阻。文献支持对无并发症的PCI进行保守治疗，将手术保留用于并发症或无法排除危及生命情况时。
本病例突出了创伤中PCI的诊断挑战。气腹并不总是表明存在穿孔。全面的诊断方法对于避免不必要的切除以及识别诸如消化性溃疡病等潜在病症至关重要。
