Intestinal cystic pneumatosis as a cause infrequent of pneumoperitoneum

Abstract

Introduction: Intestinal cystic pneumatosis is characterized by the presence of gas cysts located in the submucosa or subserosa of the intestinal wall, this pathology predominates in the male sex and its most frequent location is the colon. The pathogenesis is poorly understood, and is probably multifactorial, being idiopathic in 15% of all cases or secondary to a wide variety of diseases in 85%. Complications occur in 3% of cases, including pneumoperitoneum may occur due to rupture of subserous cysts, whose treatment is conservative in most cases.

Objective: Clinical case description, focused on intestinal cystic pneumatosis as a cause infrequent of pneumoperitoneum

Material and Methods: Clinical case description of an 67-year-old female patient with a medical history of chronic obstructive pulmonary disease without treatment, with abdominal pain in right hypochondrium, several years of evolution, which is exacerbated in the last 24 hours of mild intensity. Physical examination presents normal vital signs. Abdominal distention, pain at palpation in right hypochondrium, positive Murphy, without signs of peritonism. In standard chest x-ray image of pneumoperitoneum, in ultrasound of the upper abdomen multiple gallbladder stones were found. It was decided to practice a conventional cholecystectomy,finding intestinal cystic pneumatosis. The evolution of the patient was favorable.

Results: After patient evaluation, its diagnosis and an urgent surgical intervention was determined to avoid later complications. An initial diagnostic of cholelithiasis and pneumoperitoneum were suspected in the study.The cause of pneumoperitoneum was determined during the surgical procedure, finding intestinal cystic pneumatosis.

Conclusions: Intestinal cystic pneumatosis is a radiological or endoscopic sign, characterized by the presence of gas in the intestinal wall. The pathogenesis is poorly understood, and is probably multifactorial. The rupture of these cysts, in few conditions causes pneumoperitoneum, usually asymptomatic with conservative treatment.