Pneumatosis intestinalis, a surgical emergency

A 77-year-old woman with a history of surgery due to intestinal obstruction caused by an adhesion band came to the emergency room due to progressive abdominal pain and constipation over the previous 24 h. Abdominal computed tomography showed considerable pneumoperitoneum and fluid, suggestive of a perforation with generalized peritonitis and pneumatosis in the descending colon and small intestine, with no signs of intestinal ischemia (Fig. 1), which was resected (Fig. 2). We reviewed the entire intestinal package but found no interruption or signs of ischemia. The patient presented no postoperative complications.

Fig. 1.

Abdominal CT scan: pneumoperitoneum and pneumatosis intestinalis.

Fig. 2.

Intestinal loops with abundant wall pneumatosis.

Diagnosis: intestinal obstruction with pneumatosis.