Cystic Intestinal Pneumatosis Simulating Hollow Organ Perforation Peritonitis: A Case Report

Abstract

Cystic pneumatosis of the intestine is a rare condition whose incidence is often underestimated due to the frequency of minimally symptomatic or asymptomatic forms. Primary forms are even less common and account for only 15% of all retained cases of this disease. Peptic ulcers and pyloric stenosis are the most frequently incriminated aetiologies in the pathophysiology of the secondary form of cystic pneumatosis. We describe the case of a 60 year old patient, admitted with generalized abdominal pain complicated by the appearance of mental confusion. Clinical examination found a Glasgow score of 13/15 with generalized abdominal sensitivity. Biological findings: hyperleukocytosis at 22370 /mm, C-reactive protein was elevated at: 73.7 mg/L. The CT scan revealed gastric and duodenal thickening associated with a medium-sized pneumoperitoneum, which could be related to peritonitis due to perforation of a hollow organ. Cerebral level: Minimal meningeal haemorrhage from the brain scythe and cerebellum tent. Surgical exploration showed the appearance of cystic intestinal pneumatosis without digestive distress and without solution of continuity of a hollow organ.