Pneumoperitoneum revealing pneumatosis cystoides intestinalis and stenosing pyloro-duodenal ulcer following trauma: A case report.

INTRODUCTION

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.

CASE PRESENTATION

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.

DISCUSSION

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.

CONCLUSION

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.