Pneumatosis cystoides intestinalis with colonic perforation: A case report and literature review.

RATIONALE: Pneumatosis cystoides intestinalis (PCI) is an uncommon complaint that can produce free gas below the diaphragm, mimicking gastrointestinal perforation, which can easily lead to misdiagnosis. Although prognosis is generally good in most cases, complications can pose a threat to life and may require surgical intervention. Currently, clear surgical guidelines for PCI complicated by colonic perforation are lacking. PATIENT CONCERNS AND DIAGNOSES: We present the case of a 57-year-old male patient with pneumatosis cystoides intestinalis complicated by colonic perforation. The patient was admitted because of persistent upper abdominal pain for 3 days, which worsened over 5 hours. The client suffered from a history of chronic obstructive pulmonary disease, pulmonary bullae, and heart failure. INTERVENTIONS AND OUTCOMES: Emergency surgery was performed, during which severe abdominal contamination, significant colon dilation, cystic bubbles in the intestinal wall, and perforation of the splenic flexure of the transverse colon were observed. Consequently, the doctors performed partial colectomy and colostomy. Postoperatively, due to recurrent fever symptoms, he was transferred to a higher-level hospital for further treatment and was ultimately discharged successfully. LESSONS: PCI combined with colonic perforation should be regarded as a routine differential diagnosis for urgent abdominal pain. Although conservative treatment is the preferred option in most cases, timely surgical intervention should be considered in the presence of complications, hemodynamic instability, signs of peritonitis, and significant abnormal laboratory and imaging findings. Based on the current evidence, partial colectomy with colostomy is recommended for patients undergoing PCI combined with colonic perforation.