Pneumatosis Intestinalis: A Rare Manifestation of Acute Appendicitis

Hung Jia Pai, Chia Siu Wang, Ching Chuan Hsieh, Wen Ke Wang, Bor Yau Yang

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Pneumatosis intestinalis (PI), the presence of gas within the bowel wall, is a rare condition. To our knowledge, only two cases of PI secondary to acute appendicitis have been reported in the literature. We present a new case of a 46-year-old man who complained of abdominal pain and progressive abdominal distension for 4 days and oliguria for 1 day. In the Emergency Department, his abdomen was markedly distended and showed peritoneal signs. Preoperative blood culture grew Bacteroides fragilis. Abdominal computed tomography scan revealed marked bowel distension, bubble-like intramural gas scattered in the proximal small bowel, and localized fluid accumulation in the right lower quadrant of the abdomen. Small bowel ischemia was interpreted preoperatively. Emergency laparotomy revealed that the appendix was gangrenous and perforated, with local abscess formation but no bowel infarction. Hence, only appendectomy was performed, with subsequent uneventful patient recovery. The presence of PI may not always be an ominous sign; rather, it depends on the severity of any underlying diseases.

Original languageEnglish
Pages (from-to)127-130
Number of pages4
JournalJournal of Emergency Medicine
Issue number2
Publication statusPublished - Aug 1 2009
Externally publishedYes


  • acute abdomen
  • Acute appendicitis
  • intra-abdominal abscess
  • perforation
  • pneumatosis intestinalis

ASJC Scopus subject areas

  • Emergency Medicine


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