Pneumatosis intestinalis with pneumoperitoneum misdiagnosed as acute abdomen - a case report

Background: Pneumatosis intestinalis (PI), is defined as the presence of intramural gas within the bowel wall.Pneumatosis intestinalis is not a diagnosis.It is more a histological finding or a radiology sign, rather than a disease on itself.In most of the cases it is a benign finding, but it may be a reason for an unnecessary laparotomy, especially when associated with pneumoperitoneum.Case report: We present a case of pneumatosis intestinalis in a patient with a chronic obstructive pulmonary disease misdiagnosed as intestinal perforation due to bowel ischemia.The patient was admitted with increasing abdominal pain and nausea.On examination the abdomen was tender with diffuse pain.Plain X-rays and CT scans showed pneumoperitoneum with intramural gas in small intestine's wall.With preoperative diagnosis of bowel ischemia the patient underwent exploratory laparotomy, on which a benign PI was found.Conclusion: Carefully taken medical history, prompt exam, laboratory and instrumental data all should be carefully analyzed before a decision for emergency operation is done.It is important to divide PI in two categories-benign and life-threating.