Extensive inflammatory adhesion of small bowel with massive Pneumatosis Intestinalis in a patient with gastric outlet obstruction: A rare case report.

introductionPneumatosis Intestinalis (PI) is a rare disease, majority of which are self-limited processes, in which the intestinal sub mucosa and sub serosa are filled with gas-filled cysts. The exact cause and pathogenesis is not well known yet but there are different theories. The two well accepted fundamental pathogenesis is: mechanical and bacterial. CASE PRESENTATION: Here we report a case of a 25 years old patient presented with history of persistent vomiting, intermittent abdominal cramp and significant weight loss over three months. The primary diagnosis was made as gastric outlet obstruction with concomitant small bowel extensive PI. DISCUSSION: Primary PI has no known cause while secondary type has proposed underlying pathologies with different theorized pathogenesis. The current case report has an underlying pathology of long standing peptic ulcer disease with recent diagnosis of gastric outlet obstruction in favor of the mechanical theory. PI has a broad spectrum of clinical symptoms; ranges from asymptomatic patients to non-specific gastrointestinal symptoms like diarrhea, abdominal distention, weight loss, bloody or mucous stool. Patients with underlying pyloric stenosis, peptic ulcer disease presents with more of upper GI symptoms. Conservative management is usually the treatment of choice. However, surgery must be considered if peritoneal irritation or bowel obstruction appears overt.

conclusionConcomitant occurrence of gastric outlet obstruction with small bowel PI is not uncommon disease but severe and extensive inflammatory adhesion was rarely reported. Therefore surgical intervention is mandated for the former or both depending the severity of the PI.