A Case of Small Bowel Necrosis Ascertained during Observation of Pneumatosis Cystoides Intestinalis

Abstract

A 91-year-old woman presented to our hospital with vomiting and abdominal pains. Her white blood cell count was as high as 15,480/μl. There was only mild tenderness in the abdomen. Radiologic imaging confirmed three signs including pneumatosis cystoides intestinalis, abdominal free air, and portal venous gas, while apparent bowel ischemia was absent. She was thus monitored over time with gastric tube decompression. Contrast-enhanced CT scan 48 hours after her admission demonstrated that the portal venous gas had disappeared and the abdominal free air decreased. However, bowel ischemia prompted emergent enterectomy. She was discharged 24 days after the operation.

We must remain alert for a possibility that the small bowel which is intact at the diagnosis despite the presence of three signs can become necrotic.