Pneumatosis cystoides coli with free air mimicking perforated hollow viscus

초록

Pneumatosis cystoides coli, also called pneumatosis cystoides intestinalis, or pneumatosis coli, is a rare condition characterized by the presence of gaseous cysts in the colon wall that may be associated with a wide variety of diseases. This condition accompanied with intraperitoneal free air is extremely uncommon and is difficult to diagnose differentially from perforated hollow viscus. We present a unique case of pneumatosis cystoides coli associated with intraperitoneal free air that mimicked perforated hollow viscus. A 73-year-old male presented complaints of vague periumbilical pain, cough and febrile sense for 2 days. He had underwent a subtotal gastrectomy for traumatic gastric perforation 13 years ago. Upon arrival, his vital signs were stable with the exception of body temperature, which was 38.2 °C. The pain was not well localized, with a dull pain in the periumbilical region but the abdominal examination showed no relevant physical findings, in particular there was no palpable mass. Blood biochemistry revealed increased white blood cell (12,940/μL) and elevated serum C-reactive protein level (8.84 mg/dL). The abdominal plain film showed a massively dilated stomach with food material and intraperitoneal free air.