Presentation
Diffuse abdominal pain of 3 days since onset, associated with fetid and abundant diarrheal stools that were black in color like tar. The day before consulting, the patient began with abundant coffee grounds vomiting.
Patient Data
In the ultrasound study, conducted at the level of the intestinal loops with predominance in the mesogastrium, the presence of gas in the intestinal wall was observed, along with thickening, visualized at approximately 20 centimeters in longitudinal projections, thickening of the intestinal wall (12 mm), additionally, free fluid was visualized, evidence of an inflammatory process.
The imaging findings were reported as evidence of intestinal pneumatosis, with mesenteric thrombosis considered as the primary potential cause.
Case Discussion
Pneumatosis intestinalis refers to the presence of gas within the wall of the intestine (submucosa or subserosa layer). It was first described in 1783 by Du Vernoi, but the pathogenesis is still unknown; however, it has been associated with cases of intestinal ischemia and eventually necrosis.
Pneumatosis intestinalis can be an incidental finding and may have an indolent course; however, most cases will require surgery, such as in mesenteric ischemia or intestinal obstruction.
In this case, the patient was taken to the operating room, where surgical findings revealed marked changes in the color of the intestinal loops. Approximately 80 cm of the jejunum was resected, confirming the radiological findings of pneumatosis intestinalis due to mesenteric thrombosis.
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