Recurrent extensive idiopathic pneumatosis intestinalis of the small intestine with pneumoperitoneum: Effective treatment with the surgical intervention

Abstract

A 72-year-old man complained of a 7-days’ history of abdominal distension, diarrhea, and anorexia. The chest and abdominal plain films, and the abdominal computed tomography (CT) showed a large amount of intra-abdominal free air, and the gas in the wall of the small intestine and the mesentery. Viewing the CT images with the lung window clearly revealed the presence of a huge gas in the small intestinal wall and the mesentery, the intramural gas spreading approximately 1 m in the length. There were no signs of inflammation. He was diagnosed to have extensive idiopathic pneumatosis intestinalis with pneumoperitoneum. The symptoms were relieved by the conservative treatments. The intestinal pneumatosis, however, recurred shortly after starting the oral feeding. The pneumatosis appeared to spread from the localized region of the jejunum. Then, the laparoscopy-assisted partial resection of the jejunum (30 cm in the length) was performed. Pathological examination of the removed specimen revealed the presence of multiple gas-filled cysts in the jejunal wall, but no breaks on the mucosal surface. The cysts were not lined by epithelial cells, but were surrounded by many macrophages. He became completely free of the pneumatosis after the surgery. The findings indicate that the surgical intervention should be considered in certain patients with recurrent extensive idiopathic pneumatosis intestinalis.