Marcus Cezillo (Osasco / BR), Robson Uwagoya (Osasco / BR), Samanta Bueno (Osasco / BR), Paola Panadés (Osasco / BR), Hugo Gregoris de Lima (Osasco / BR)
Abstract text (incl. references and figure legends)
pneumatosis intestinalis has a wide presentation and its meaning depends on the nature and severity of the underlying condition. Due to conditions and outcomes ranging from benign diseases to abdominal sepsis and death, clinical presentation and laboratory tests are extremely important to associate with the image and offer a global assessment and correct management.
A 12-year-old boy presented to the emergency department with abdominal pain, vomiting, absence of flatulence, and constipation that have worsened in the last 7 days.
On examination, he showed abdominal distension, no bowel sounds and diffuse pain. In computed tomography was identified extensive bowel and mesentery pneumatosis, diffuse bowel distension (marked in jejune), pneumoperitoneum and pneumoretroperitoneum with no gas in the portal system.
Due to the difficulty to clear the diagnosis by the association of positive and negative signs of ischemia, exploratory laparotomy was indicated. There were extensive bowel distension with widespread subserous bubbles, wall thickening but without signs of ischemia during the intraoperative time.
No resection was necessary and the abdomen was closed. The patient had a slow diet progression and recovering. It is very difficult to differentiate between benign and ischemic causes when symptoms, signs, patient and image are not completely clear.
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