Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 21, 2008; 14(43): 6753-6756
Published online Nov 21, 2008. doi: 10.3748/wjg.14.6753
Pneumatosis cystoides intestinalis associated with massive free air mimicking perforated diffuse peritonitis
Yoichi Sakurai, Masahiro Hikichi, Jun Isogaki, Shinpei Furuta, Risaburo Sunagawa, Kazuki Inaba, Yoshiyuki Komori, Ichiro Uyama
Yoichi Sakurai, Masahiro Hikichi, Jun Isogaki, Shinpei Furuta, Risaburo Sunagawa, Kazuki Inaba, Yoshiyuki Komori, Ichiro Uyama, Department of Surgery, Fujita Health University School of Medicine, Toyoake Aichi 470-1192, Japan
Author contributions: Sakurai Y, Hikichi M, Isogaki J, Furuta S, Sunagawa R, and Uyama I performed the operations; Inaba K and Komori Y were the consultants overseeing the patients’ care; Sakurai Y wrote the manuscript.
Correspondence to: Yoichi Sakurai, MD, PhD, FACS, Department of Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-cho, Toyoake Aichi 470-1192, Japan. ysakurai@fujita-hu.ac.jp
Telephone: +81-562-93-9254 Fax: +81-562-93-9011
Received: August 28, 2008
Revised: October 21, 2008
Accepted: October 28, 2008
Published online: November 21, 2008
Abstract

While pneumatosis cystoides intestinalis (PCI) is a rare disease entity associated with a wide variety of gastrointestinal and non-gastrointestinal disorders, PCI associated with massive intra- and retroperitoneal free air is extremely uncommon, and is difficult to diagnose differentially from perforated peritonitis. We present two cases of PCI associated with massive peritoneal free air and/or retroperitoneal air that mimicked perforated peritonitis. These cases highlight the clinical importance of PCI that mimics perforated peritonitis, which requires emergency surgery. Preoperative imaging modalities and diagnostic laparoscopy are useful to make an accurate diagnosis.

Keywords: Pneumatosis cystoides intestinalis; Perforated peritonitis; Corticosteroid therapy; Peritoneal free air