Pneumatosis intestinalis presenting as pneumoperitoneum in a teenage girl with pyloric stenosis

Pneumatosis cystoides intestinalis with pneumoperitoneum secondary to stenosing pyloro-duodenal peptic ulcer: Case series of three patients and literature review

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Pneumatosis cystoides intestinalis (PCI) is a rare condition which can be associated to pneumoperitoneum without gastro-intestinal perforation.

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PCI is most often secondary to various diseases and the stenosing peptic ulcer is one of them.

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Careful correlation of the clinical presentation with corroborating biological tests should determine whether a conservative medical approach or emergency surgical exploration is appropriate.

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Knowledge of this pathology is important to avoid unnecessary exploratory laparotomy.

Introduction

Pneumatosis cystoides intestinalis (PCI) is a rare condition, which can affect the entire gastro-intestinal tract. It can be idiopathic or most often secondary to various diseases. The causes remain multiple and the stenosing peptic ulcer is one of them. We report three case reports of pneumatosis cystoides with pneumoperitoneum intestinalis secondary to stenosing pyloro-duodenal peptic ulcer.

Case presentation

We report a case series of three patients with PCI that presented to the emergency department with a reassuring clinical picture with the discovery in imaging of a pneumoperitoneum. All our patients presented with a pyloro-duodenal stenosis secondary to a complicated peptic ulcer, one of which was treated surgically and the other two endoscopically.

Discussion

The objective of this report is to provide an update on pneumatosis cystoides intestinalis secondary to stenosing pyloro-duodenal peptic ulcer, by specifying its etiopathogenic, diagnostic and therapeutic characteristics.

Conclusion

Knowledge of this pathology is necessary in order to avoid unnecessary abusive surgery.