Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient: A case report

Shuhei Ito, Takaaki Masuda, Noboru Harada, Ayumi Matsuyama, Motoharu Hamatake, Takashi Maeda, Shinichi Tsutsui, Hiroyuki Matsuda, Koshi Mimori, Teruyoshi Ishida

Research output: Contribution to journalArticle

Abstract

Introduction Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. Presentation of case A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. Discussion Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. Conclusion Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.

Original languageEnglish
Pages (from-to)109-113
Number of pages5
JournalAnnals of Medicine and Surgery
Volume21
DOIs
Publication statusPublished - Sep 1 2017

Fingerprint

Laparoscopy
Emergencies
Air
Frail Elderly
Systemic Inflammatory Response Syndrome
Vital Signs
Small Intestine
Cysts
Ischemia
Gases
Tomography
Inflammation

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient : A case report. / Ito, Shuhei; Masuda, Takaaki; Harada, Noboru; Matsuyama, Ayumi; Hamatake, Motoharu; Maeda, Takashi; Tsutsui, Shinichi; Matsuda, Hiroyuki; Mimori, Koshi; Ishida, Teruyoshi.

In: Annals of Medicine and Surgery, Vol. 21, 01.09.2017, p. 109-113.

Research output: Contribution to journalArticle

Ito, Shuhei ; Masuda, Takaaki ; Harada, Noboru ; Matsuyama, Ayumi ; Hamatake, Motoharu ; Maeda, Takashi ; Tsutsui, Shinichi ; Matsuda, Hiroyuki ; Mimori, Koshi ; Ishida, Teruyoshi. / Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient : A case report. In: Annals of Medicine and Surgery. 2017 ; Vol. 21. pp. 109-113.
@article{31be7fc7d8d24ad1bd14dc9c09080c81,
title = "Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient: A case report",
abstract = "Introduction Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. Presentation of case A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. Discussion Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. Conclusion Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.",
author = "Shuhei Ito and Takaaki Masuda and Noboru Harada and Ayumi Matsuyama and Motoharu Hamatake and Takashi Maeda and Shinichi Tsutsui and Hiroyuki Matsuda and Koshi Mimori and Teruyoshi Ishida",
year = "2017",
month = "9",
day = "1",
doi = "10.1016/j.amsu.2017.07.058",
language = "English",
volume = "21",
pages = "109--113",
journal = "Annals of Medicine and Surgery",
issn = "2049-0801",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient

T2 - A case report

AU - Ito, Shuhei

AU - Masuda, Takaaki

AU - Harada, Noboru

AU - Matsuyama, Ayumi

AU - Hamatake, Motoharu

AU - Maeda, Takashi

AU - Tsutsui, Shinichi

AU - Matsuda, Hiroyuki

AU - Mimori, Koshi

AU - Ishida, Teruyoshi

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Introduction Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. Presentation of case A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. Discussion Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. Conclusion Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.

AB - Introduction Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. Presentation of case A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. Discussion Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. Conclusion Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.

UR - http://www.scopus.com/inward/record.url?scp=85026772456&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026772456&partnerID=8YFLogxK

U2 - 10.1016/j.amsu.2017.07.058

DO - 10.1016/j.amsu.2017.07.058

M3 - Article

AN - SCOPUS:85026772456

VL - 21

SP - 109

EP - 113

JO - Annals of Medicine and Surgery

JF - Annals of Medicine and Surgery

SN - 2049-0801

ER -