Pneumatosis intestinalis and pneumoperitoneum on computed tomography: Beware of non-therapeutic laparotomy.

Pneumatosis intestinalis (PI) is defined as gas within the gastrointestinal wall and is associated with a variety of disorders. As a concurrent occurrence with pneumoperitoneum, it can easily to be mistaken for bowel ischemia with perforated peritonitis. In fact, air dissection or rupture from subserosal cysts may be the cause of intraperitoneal and intraluminal free air, with clinical symptoms such as abdominal pain and fullness occurring as a result. We hereby report a case of an 82-year-old male with a history of chronic obstructive pulmonary disease who was diagnosed with bowel ischemia and received emergency laparotomy because of the appearance of PI and pneumoperitoneum on abdominal computed tomography scan. However, no perforated hollow organ or necrotic bowel segment was found, only diffusely distributed massive intraperitoneal air and PI of gastrointestinal tract. The laparotomy seemed non-therapeutic for this patient. This is significant warning for clinicians to differentiate the associated conditions of PI, and to evaluate whether or not emergency surgery is necessary.