Non-Ischemic Pneumatosis Coli in Acute Abdomen

Figure

Erect abdominal radiograph showing pneumatosis intestinalis with intramural gas projected onto the left upper abdomen.

A 75-year-old female patient presented at the emergency department with upper abdominal pain that had been present for 1 day. Right hemicolectomy had been performed 8 years previously for colon cancer. Pain upon pressure to the upper abdomen and early abdominal guarding was clinically striking. CRP was elevated at 161.3 mg/L, while white blood cell count was normal. Abdominal radiography revealed pneumatosis intestinalis in the left upper abdomen. Computed tomography confirmed the suspected diagnosis of pneumatosis coli. Cholecystitis and formation of mucocele of the gallbladder was also visualized. Apart from gangrenous cholecystitis, no signs of intestinal ischemia were seen intraoperatively. The patient was discharged without symptoms on the sixth postoperative day. Non-ischemic pneumatosis intestinalis is a differential diagnosis of unknown incidence to acute mesenteric ischemia, which requires immediate treatment. Causes include immunosuppression, steroid use, intestinal infection, inflammatory bowel disease, or reduced gastrointestinal motility. Since the non-ischemic etiology of pneumatosis intestinalis cannot be definitively confirmed on imaging, a correlation with symptoms and relevant laboratory parameters is always required.

Dr. med. Rafael Heiss, Dr. med. Marco Wiesmüller, Prof. Dr. med. Michael Uder, Radiologisches Institut, Universitätsklinikum Erlangen, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Heiss R, Wiesmüller M, Uder M: Non-ischemic pneumatosis coli in acute abdomen. Dtsch Arztebl Int 2020; 117: 877. DOI: 10.3238/arztebl.2020.0877