Pneumatosis Cystoides Intestinalis; A Rare Cause of Ileus Mimicking Intestinal Perforation

Öz

Abstract Pneumatosis Cystoides Intestinalis (PCI) is a rare condition that many physicians find challenging to diagnose. PCI is characterized by the presence of gas-filled cysts in the submucosa and serosa of the gastrointestinal system. It can develop due to trauma caused by conditions such as pyloric stenosis, peptic ulcers, ileus and endoscopic procedures. The exact etiology of PCI remains unclear. Treatment is directed towards the underlying cause. Surgical intervention should be considered only after the etiology is clarified or when acute surgical pathologies are detected. In this article, we present a 45-year-old male with a history of peptic ulcer and intermittent abdominal pain for the past 10 years. The patient was referred from an external center with a preliminary diagnosis of hollow organ perforation. During the diagnostic process, PCI and perforation were considered in the differential diagnosis. The patient developed ileus and an acute abdomen during follow-up, which necessitated surgical intervention.

Anahtar Kelimeler

• Pneumatosis Cystoides Intestinalis
• Ileus
• Intestinal Perforation

Kaynakça

1. 1. Ling F, Guo D, Zhu L. Pneumatosis cystoides intestinalis: a case report and literature review. BMC Gastroenterol. 2019;19(1):176.
2. 2. Gedik E, Girgin S. Peptik ülser perforasyonu ve kronik obstruktif akciğer hastalığı bulunan bir hastada Pnömatozis sistoides intestinalis. Akademik Gastroenteroloji Dergisi. 2006;5(2): 137-9.
3. 3. Greenstein AJ, Nguyen SQ, Berlin A, et al. Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality. J Gastrointest Surg. 2007;11(10):1268-74.
4. 4. Ma W, Zhang C, Sun MW, Cai B. Pneumatosis cystoides intestinalis: A case report and literature review. Asian J Surg. 2023 Jun;46(6):2581-2.
5. 5. El Hattabi K, Lafkih O, Bensardi F, Elbakouri A, Bouali M, Fadil A. Pneumatosis cystoides intestinalis with pneumoperitoneum secondary to stenosing pyloro-duodenal peptic ulcer: Case series of three patients and literature review. Int J Surg Case Rep. 2021 Apr;81:105772.
6. 6. Wu LL, Yang YS, Dou Y, et al. A systematic analysis of pneumatosis cystoides intestinalis. World J Gastroenterol. 2013;19(30):4973-8.
7. 7. Wang YJ, Wang YM, Zheng YM, et al. Pneumatosis cystoides intestinalis: six case reports and a review of the literature. BMC Gastroenterol. 2018;18(1):100.
8. 8. Brighi M, Vaccari S, Lauro A, et al. "Cystamatic" Review: Is Surgery Mandatory for Pneumatosis Cystoides Intestinalis? Digestive diseases and sciences, 2019;64(10):2769–75.

9. 9. Kancherla D, Vattikuti S, Vipperla K. Pneumatosis cystoides intestinalis: Is surgery always indicated? Cleve Clin J Med. 2015;82(3):151-2.
10. 10. DuBose JJ, Lissauer M, Maung AA, et al. ; EAST Pneumatosis Study Group. Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2013;75(1):15-23.
11. 11. Lassandro F, Mangoni de Santo Stefano ML, Porto AM, Grassi R, Scaglione M, Rotondo A. Intestinal pneumatosis in adults: diagnostic and prognostic value. Emerg Radiol. 2010;17(5):361-5.
12. 12. Ribaldone DG, Bruno M, Gaia S, Saracco GM, De Angelis C. Endoscopic ultrasound to diagnose pneumatosis cystoides intestinalis (with video). Endosc Ultrasound. 2017;6(6):416-7.