Incidental pneumoperitoneum due to pneumatosis intestinalis: A rare case of benign pneumoperitoneum.

introduction and significancePneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a rare but significant gastrointestinal condition. It may be associated with underlying gastrointestinal disorders or detected incidentally, posing diagnostic challenges. This article emphasizes the importance of recognizing and managing this condition conservatively when appropriate. CASE PRESENTATION: A previously healthy 40-year-old Caucasian female patient presented with left lumbar fossa pain, initially suggestive of renal colic. Physical examination revealed stable vital signs and a soft abdomen. Laboratory tests showed no signs of inflammation or renal abnormalities. Abdominal CT scan ruled out urinary lithiasis but identified pericolonic pneumoperitoneum on the left side. Due to the absence of peritonitis signs, surgical intervention was deferred. Over 72 h of close monitoring, the patient remained stable without clinical deterioration. Subsequent CT scans confirmed pneumatosis intestinalis. The patient remained asymptomatic and underwent a confirming colonoscopy. CLINICAL DISCUSSION: Pneumatosis intestinalis can manifest with varying severity and is often linked to underlying gastrointestinal conditions. It can mimic life-threatening conditions like bowel perforation, necessitating careful differentiation. Non-surgical pneumoperitoneum, exemplified in this case, may result from benign causes like PI, warranting meticulous evaluation to prevent unnecessary surgery.

conclusionThis case highlights the need to recognize and manage asymptomatic PI. A multidisciplinary approach and CT imaging play pivotal roles in ensuring optimal patient outcomes. Vigilance among healthcare professionals is essential to consider PI in asymptomatic patients, mitigating the risk of undue surgical interventions, and facilitating timely diagnosis and intervention when necessary.