Pneumoperitoneum revealing pneumatosis cystoides intestinalis and stenosing pyloro-duodenal ulcer following trauma: A case report.

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.