A Case of Gastroduodenal Pneumatosis Intestinalis with Peritoneal Free Air Associated with Superior Mesenteric Artery Syndrome

Abstract

A 66-year-old woman was evaluated for vomiting and weight loss. A CT scan showed marked gastric and duodenal dilatation with air bubbles in the duodenal wall. The third portion of the duodenum was compressed between the aorta and the superior mesenteric artery (SMA). Both intra- and extra-peritoneal free air was observed around the second portion of the duodenum, and upper gastrointestinal perforation was suspected, thought due to duodenal obstruction secondary to SMA syndrome. Emergency laparotomy was then performed, which showed no perforation in the gastrointestinal tract. Air bubbles in the duodenal wall were observed, and no ascites was seen. The diagnosis of pneumatosis intestinalis (PI) was made, and a transgastric tube-jejunostomy was placed. The symptoms disappeared with gastric drainage, and the postoperative course was uneventful. PI is known to occur secondary to a variety of diseases. PI may be accompanied by peritoneal free air, and surgical intervention is needed in such patients. The therapeutic strategy must be determined based on the clinical findings and etiology. Laparoscopic exploration may be considered to avoid unnecessary laparotomy.