International journal of surgery case reports · 2025
Pneumoperitoneum revealing pneumatosis cystoides intestinalis and stenosing pyloro-duodenal ulcer following trauma: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Karoui Yasser, Kebir Ghassen Hamdi, Mazlout Majed, El Heni Sirine, Maatouk Mohamed, Moussa Mounir Ben
Аннотация
INTRODUCTION: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the intestines. We report a case in which PCI with pneumoperitoneum was incidentally discovered following trauma, revealing an underlying stenosing pyloro-duodenal ulcer.
CASE PRESENTATION: A 60-year-old man was admitted after a road traffic accident. Computed tomography revealed significant pneumoperitoneum without signs of organ injury. Emergency laparotomy showed extensive PCI involving the small bowel, without any perforation. Postoperative esophagogastroduodenoscopy confirmed a markedly dilated stomach and a completely stenosing duodenal ulcer. The patient subsequently underwent antrectomy with gastrojejunostomy and bilateral vagotomy. The postoperative course was uneventful, and histopathology showed no malignancy.
DISCUSSION: PCI may mimic surgical emergencies such as gastrointestinal perforation. In this patient, trauma revealed both PCI and a previously undiagnosed gastric outlet obstruction. The literature supports conservative management in uncomplicated PCI, reserving surgery for complications or when life-threatening conditions cannot be excluded.
CONCLUSION: This case highlights the diagnostic challenge of PCI in trauma. Pneumoperitoneum does not always indicate perforation. A comprehensive diagnostic approach is essential to avoid unnecessary resections and to identify underlying conditions such as peptic ulcer disease.
CASE PRESENTATION: A 60-year-old man was admitted after a road traffic accident. Computed tomography revealed significant pneumoperitoneum without signs of organ injury. Emergency laparotomy showed extensive PCI involving the small bowel, without any perforation. Postoperative esophagogastroduodenoscopy confirmed a markedly dilated stomach and a completely stenosing duodenal ulcer. The patient subsequently underwent antrectomy with gastrojejunostomy and bilateral vagotomy. The postoperative course was uneventful, and histopathology showed no malignancy.
DISCUSSION: PCI may mimic surgical emergencies such as gastrointestinal perforation. In this patient, trauma revealed both PCI and a previously undiagnosed gastric outlet obstruction. The literature supports conservative management in uncomplicated PCI, reserving surgery for complications or when life-threatening conditions cannot be excluded.
CONCLUSION: This case highlights the diagnostic challenge of PCI in trauma. Pneumoperitoneum does not always indicate perforation. A comprehensive diagnostic approach is essential to avoid unnecessary resections and to identify underlying conditions such as peptic ulcer disease.