A 23-years-old man diagnosed in childhood as having chronic idiopathic intestinal pseudoobstruction (CUP) and admitted for abdominal fullness and weight loss in December 2005. He underwent conservative therapy with total parenteral nutrition (TPN). In August 2006, his high fever and abdominal fullness became aggravated, suggesting acute peritonitis. Abdominal X ray imaging showed on enlarged intestine and subphrenic free air, but not peritonitis irritation. He was eventually diagnosed with pneumatosis cystoides intestinalis (PCI) with CUP. Abdominal contrast-enhanced computed tomography (CT) showed no ascites, but indicated a double-layered structure at the small intestinal wall. Ten days after long-tube suction, enhanced CT showed that free air had decreased and PCI had disappeared. Emergency surgery was previously recommended for intestinal obstruction accompanied by free air with PCI because of suspected intestinal perforation. Our case suggests that surgical decision-making be done more circumspectly.
- Diffuse peritonitis
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