Abstract Pneumatosis intestinalis coli is a condition characterized by the presence of gas within the wall of the bowel and can be identified by imaging studies. It may be associated with both benign and life-threatening conditions. The benign form of pneumatosis intestinal includes conditions like pulmonary disease, systemic sclerosis, iatrogenic causes, and drugs. On the other hand, malignant pneumatosis intestinal is most often associated with bowel ischemia, intestinal infarction, toxic megacolon, vascular diseases, connective tissue disorders, or bowel obstruction. This case report is about a unique presentation of pneumatosis intestinalis coli in a patient with a long history of abdominal surgeries presenting with severe abdominal pain. The initial clinical suspicion was toward small bowel obstruction possibly due to adhesions, but the imaging studies showed pneumatosis intestinalis coli associated with pneumoperitoneum without any definite underlying cause being evident. These concerning radiological features did not reveal the typical clinical severity associated with malignant etiology, thus presenting a challenge to diagnosis and management. We aim to draw attention to the diagnostic subtlety of pneumatosis intestinalis by underlining the need for differentiation into benign and malignant causes. This will help guide the degree and type of intervention, from conservative to surgical exploration. In this case, we discuss in detail the diagnostic approach, clinical presentation, and decision-making strategies guiding this patient's management from admission to discharge. By doing so, we aim to provide insight into this radiologic finding and how it may or may not clinically correlate as expected.
Raj et al. (Fri,) studied this question.