Pneumatosis intestinalis

Letters

CJEM 2004;6(1):10-11

To the Editor: I would like to commend Dr. Liu and colleagues on their excellent case report,¹ "Benign pneumatosis intestinalis: a cause of massive pneumoperitoneum in the adult." The Canadian Journal of Emergency Medicine arrived at my house on Wednesday, and by Friday I was able to put the article and its excellent photoradiographs to good use. In doing so I noted that this syndrome is not discussed in Rosen's Emergency Medicine textbook.

My interest in your case report arose when a 90-year-old woman was transferred from another institution to us via our imaging department. She had suffered the onset of abdominal pain and bloating that morning, and the CT revealed massive pneumoperitoneum. The attending surgeon requested that preparations be made for immediate laparotomy pending his arrival. As emergency physicians generally attempt to do with all patients passing through their department, I quickly reviewed the patient, noting how benign her belly felt, and noting the presence of normal laboratory values. At this point I reviewed the CT report, which read: "massive pneumoperitoneum suggestive of air-filled cystic structures."

Following discussion with the attending surgeon and CT radiologist, it was agreed that the patient did not warrant immediate laparotomy. By the following day the patient was able to start eating again. No ischemia, inflammation nor increased intraluminal pressure effect was identified.

I thank you for this excellent Case Report.

George Pugh, MD, MHSc
Attending Emergency Physican
Mount Saint Joseph Hospital
Providence Health Care Society
Vancouver, BC

Reference

1. Liu DM, Torreggiani WC, Rowan K, Nicolaou S. Benign pneumatosis intestinalis: a cause of massive pneumoperitoneum in the adult. Can J Emerg Med 2003;5(6):416-20.