Intest Res.  2015 Oct;13(4):346-349. 10.5217/ir.2015.13.4.346.

A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis

• Rathi C
• Pipaliya N
• Poddar P
• Pandey V
• Ingle M
• Sawant P

• KMID: 2070751
• DOI: http://doi.org/10.5217/ir.2015.13.4.346

Abstract

Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.

Keyword

Mesenteric ischemia; Pneumatosis cystoides intestinalis; Pneumoperitoneum

MeSH Terms

Abdominal Pain
Gastroenterology
Humans
Ileum
Ischemia
Laparotomy
Mesenteric Artery, Superior
Mesenteric Veins
Mesentery*
Middle Aged
Pneumatosis Cystoides Intestinalis*
Pneumoperitoneum

Figure

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  Fig. 1 CT findings. Contrast-enhanced CT of the abdomen (lung window) demonstrating pneumatosis cystoides intestinalis involving the small bowel loops.

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  Fig. 2 CT findings. Contrast-enhanced CT of the abdomen (axial section) demonstrating twisting of the mesentery and branches of the superior mesenteric artery and vein (arrow).

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  Fig. 3 Intra-operative findings. Segmental pneumatosis intestinalis involving the ileal loops. The small bowel mesentery is long and hypermobile (arrow).

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  Fig. 4 CT findings. Contrast-enhanced CT of the abdomen (lung window) demonstrating a tiny focus of pneumoperitoneum in the perihepatic region (arrow).

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  Fig. 5 Gross findings. Resected specimen of ileum with pneumatosis cystoides intestinalis.

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  Fig. 6 Pathologic findings. Histopathology of the resected specimen of ileum demonstrating an air-filled cyst within the mucosa (arrow). Hematoxylin and eosin stain (H&E, ×40).

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