2025 Volume 67 Issue 9 Pages 1443-1449
An 82-year-old woman presented with severe lower abdominal pain. Physical examination revealed abdominal distension and tenderness. CT demonstrated dilation of the sigmoid colon, a whirl sign of the sigmoid mesocolon, pneumatosis intestinalis in the sigmoid colon, and a small amount of intraperitoneal free air. Given her stable general condition, absence of significant peritoneal irritation signs, and normal laboratory findings, the intraperitoneal free air was attributed to pneumatosis intestinalis rather than perforation secondary to sigmoid volvulus. Endoscopic detorsion was successfully performed, and the postoperative course was uneventful. However, 1.5 months later, the sigmoid volvulus recurred. Endoscopic detorsion was repeated, followed by laparoscopic sigmoidectomy to prevent further recurrence. Prolonged exposure to trichloroethylene in the workplace was considered a potential cause of the intestinal pneumatosis. This case highlights the clinical significance of recognizing that intraperitoneal free air can occur in patients with pneumatosis intestinalis without gastrointestinal perforation.
