Pneumatosis coli

Case contributed by María Augusta Serrano Cueva
Diagnosis certain

Presentation

The patient presented without significant past medical history, with a gastrostomy tube (G-tube). Presenting with diffuse abdominal pain for the last 72 hours.

Patient Data

Age: 90 years
Gender: Male
ct

Lung windows show severe pneumatosis of the ascending and transverse colon, associated with free intra-abdominal gas.

There is marked thickening of the colonic wall at the hepatic flexure secondary to the presence of intramural gas associated with free air around the stomach and adjacent to the descending colon.

Sagittal views show marked thickening of the ascending colon wall, secondary to the presence of intramural air associated with free air under the diaphragm and anterior to the ascending colon.

Specimen

pathology

Intra-op findings showed a dilated right colon with superficial dusky discolouration associated with a micro-perforation at the level of the proximal transverse colon.

Microscopic findings: upon cutting of the specimen, multiple air-filled cystic formations were identified, measuring 0.5-2 cm and diffusely distributed, resulting in a perceived spongy texture of the mucosa. Specimen demonstrated multiple intramural cystic spaces, some coated with foreign-body giant cells, others with histiocytes. Mononuclear inflammatory infiltration is also present, with focal accumulations of mononuclear cells in a diffuse distribution examination of the specimen showed a diffuse distribution of multiple air-filled cystic formations measuring 0.5-2 cm.

Histopathological diagnosis: pneumatosis cystoides coli

Case Discussion

Pneumatosis coli is a rare but benign disease characterized by intramural gas collections of encysted gas occurring within the submucosa and subserosa of the colon causing mural thickening. Patients usually present with nonspecific abdominal pain and excessive flatulence. Most causes are idiopathic but one of the most accepted theories is the entry of air through the intestinal mucosa.

This is a case of benign pneumatosis with intraperitoneal rupture and secondary colonic inflammation.

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