Presentation
Right flank pain.
Patient Data
A 7 mm stone is seen at distal one third of right ureter, accompanied by proximal moderate hydroureteronephrosis.
In addition, extensive gas bubbles in the wall of the splenic flexure of the colon with adjacent tiny bubbles of free intraperitoneal gas. There is no obvious pericolic fat stranding or collection to suggest colonic perforation.
Case Discussion
Intramural gas limited to the colonic wall in this case, compatible with pneumatosis cystoides coli which is a rare, idiopathic and usually benign condition, especially if the gas is in the form of bubbles rather than linear. These gas bubbles can rupture and cause repeated episodes of pneumoperitoneum without signs of peritonitis.
The right flank pain of this patient was attributed to the right distal ureteral stone and hydroureteronephrosis.
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