Asian Journal of Research and Reports in Gastroenterology

Exceptional Association of Pneumatosis Cystoides Intestinalis with Ascites Secondary to Gastric Ulcer

W. Hliwa

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

Z. Chraibi *

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

FZ El Rhaoussi

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

M. Tahiri

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

F. Haddad

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

A. Bellabah

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

W. Badre

Department of Gastroenterology, Ibn Rochd University Hospital, Casablanca, Morocco.

I. Bounnite

Central Radiology Service, Ibn Rochd University Hospital, Casablanca, Morocco.

M. Labied

Central Radiology Service, Ibn Rochd University Hospital, Casablanca, Morocco.

G. Lembarki

Central Radiology Service, Ibn Rochd University Hospital, Casablanca, Morocco.

C. Mountassir

Central Radiology Service, Ibn Rochd University Hospital, Casablanca, Morocco.

M. Sabiri

Central Radiology Service, Ibn Rochd University Hospital, Casablanca, Morocco.

S. Lezar

Central Radiology Service, Ibn Rochd University Hospital, Casablanca, Morocco.

*Author to whom correspondence should be addressed.

---

Abstract

Pneumatosis cystoides Intestinalis (PCI) is a rare disease characterized by the presence of gas-filled cysts in the intestinal wall, which can affect the entire digestive tract, with a predilection for the small intestine and colon. It can be primary or secondary, associated with multiple gastrointestinal or other pathologies. Diagnosis can be challenging to establish, and only a combined radiological and endoscopic evaluation ensures proper therapeutic management, often preventing unnecessary emergency surgical interventions. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications We report an unusual case of pneumatosis cystoides intestinalis associated with ascites, in a 65 year-old patient who presented with chronic abdominal pain and vomiting. The abdomen CT showed multiple small air cysts in the intestinal wall, ascites, and free abdominal air. Upper gastrointestinal endoscopy showed a gastric ulcer without no evidence of malignancy on histopathological examination, but with the presence of Helicobacter pylori. Ascitic fluid analysis revealed an exudative pattern. The patient was treated with Helicobacter pylori eradication therapy along with proton pump inhibitors. The outcome was favorable with the disappearance of abdominal pain and ascites. An abdominopelvic CT scan performed after 4 months showed complete regression of cystic images and ascites. To date, very few cases of intestinal pneumatosis associated with ascites have been reported.

Keywords: Pneumatosis cystoides intestinalis, gastric ulcer, helicobacter pylori, abdominal CT scan

---

---

---

References

Laclotte D, Bigard M. Laclotte D, Bigard M. Laclotte D, Bigard M. Pneumatose kystique intestinale. Encycl Mèd Chir (Elsevier Masson, Paris), Gastro-Entérologie,2010;9-061-A-30;8.

Serraj I, El Kihal L, Mohcine R. et al. Pneumatose kystique intestinale avec ascite: Association exceptionnelle. Acta Endosc. 2006;36:357–362. Available:https://doi.org/10.1007/BF03006042

Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA. Pneumatosis intestinalis: A review. Am J Gastroenterol. 1995;90:1747-58.

Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: Benign to life-threatening causes. AJR Am J Roentgenol. 2007;188:1604- 13.

Pear BL. Pneumatosis intestinalis: A review. Radiology. 1998;207:13-9.

Yale CE, Balish E, Wu JP. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg. 1974;109:89- 94.

Khalil PN, Huber-Wagner S, Ladurner R, Kleespies A, Siebeck M, Mutschler W. Natural history, clinical pattern and surgical considerations of pneumatosis intestinalis. Eur J Med Res. 2009;14(6):2 31–9.

Muyembe V.M. Pneumatosis cystoides intestinalis associated with ascites and pyloric stenosis secondary to a chronic duodenal ulcer: case report. East Afr Med J. 2002;79:667-8.

Serraj I, El Kihal L, Mohcine R et al. Pneumatose kystique intestinale avec ascite: association exceptionnelle. Acta Endosc. 2006;36:357–362. Available:https://doi.org/10.1007/BF03006042

El Hattabi K, Lafkih O, Bensardi F, Elbakouri A, Bouali M, Fadil A. Pneumatosis cystoides intestinalis with pneumoperitoneum secondary to stenosing pyloro-duodenal peptic ulcer: Case series of three patients and literature review. Int J Surg Case Rep. 2021;81:105772. DOI: 10.1016/j.ijscr.2021.105772 Epub 2021 Mar 13. PMID: 33743257; PMCID: PMC8010462.

Brientini F, Debilly M, Litzler JF. La Pneumatose kystique colique: Un diagnostic scanographique spécifique. J Radiol. 1995;76(2-3):135–40.

Rodriguez C, Le Roux Y. Pneumatose kystique colique droite r6v616e par un pneumop6ritoine. J Chir. 2002;139:117-9.

Hwang J. Pneumatose cystoides intestinalis with free intraperitoneal air: a case report. Am Surg 2003;69:346-9.

Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007;188:1604– 13.

Lommen MJ, Zineldine O, Mehta TI, et al. Pneumatosis Cystoides Intestinalis Identified on screening colonoscopy with associated pneumoperitoneum. Cureus 2020;12(8):e9512. DOI: 10.7759/cureus.9512

Khalil PN, Huber-Wagner S, Ladurner R, et al. Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res. 2009;14: 231–9.