Pneumatosis Cystoides Intestinalis Coli Presenting As Acute Large Bowel Obstruction: A Rare Case Report

Abstract

Background: Pneumatosis intestinalis is a rare condition characterized by the presence of gas-filled cysts within the bowel wall. Colonic involvement, termed pneumatosis cystoides intestinalis coli, is uncommon and is usually asymptomatic or associated with nonspecific gastrointestinal complaints. Presentation as sigmoid volvulus causing acute large bowel obstruction is extremely rare and may mimic malignant obstruction on imaging.

Case Presentation: A 65-year-old female presented with abdominal pain and distension for two days, obstipation for four days, and vomiting with fever for one day. Examination revealed a distended abdomen with diffuse tenderness and absent bowel sounds. Laboratory parameters were within normal limits. Contrast-enhanced CT abdomen showed multiple dilated large bowel loops with irregular wall thickening in the sigmoid colon causing luminal narrowing, raising suspicion of malignant large bowel obstruction. The patient underwent emergency exploratory laparotomy. Intraoperatively, a redundant sigmoid colon with 180-degree twist was noted. After derotation and decompression, multiple grape-like cysts were seen throughout the sigmoid colon. Sigmoidectomy with end colostomy (Hartmann’s procedure) was performed. The postoperative period was uneventful. Histopathological examination confirmed pneumatosis cystoides intestinalis. Stoma reversal with colorectal anastomosis was performed two months later.

Conclusion: Pneumatosis cystoides intestinalis coli presenting as sigmoid volvulus is exceedingly rare and can mimic malignant obstruction on imaging. Definitive diagnosis is often intraoperative or histopathological. Surgical resection is indicated in complicated cases presenting with volvulus and obstruction. Awareness of this rare presentation is important for appropriate management.