Abstract
We report a case in which a patient with pneumatosis intestinalis (PI) affecting almost the entire length of the small bowel wall was successfully treated with conservative management. An 82-year-old man was brought to hospital with a 1-month history of abdominal distention and bloody stools. He had called emergency services because of fever (37°C), dyspnea, and cyanosis. Vital signs on admission were as follows: Glasgow Coma Score, E4, V2, M6; blood pressure, 120/64 mmHg; heart rate, 116 beats/min; respiratory rate, 18 breaths/min; and body temperature, 40°C. He complained of abdominal distension, but showed no signs of peritoneal irritation. Contrast-enhanced computed tomography (CT) showed paralytic ileus and abnormal gas patterns in the wall of the small bowel. We suspected the abnormal gas was caused by bowel wall necrosis. However, we were hesitant to perform emergency laparotomy because his clinical conditions improved with administration of antibiotics and fluid replacement. Abdominal distension gradually improved. CT on day 13 did not show any abnormal gas findings. Small bowel capsule endoscopy performed on day 19 showed only a small erosive lesion in the mucosa of the small bowel. The patient was discharged uneventfully on day 29. We believe that the abnormal gas patterns in the small bowel wall indicated PI. Increased intraluminal pressure will cause PI.
