Multi-slice computed tomography diagnosis of pneumatosis cystoides intestinalis with pneumoperitoneum in high-altitude regions: preventing unnecessary laparotomies.

Background: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple intramural gas cysts in the submucosa or subserosa of the bowel wall. However, in high-altitude areas, PCI with pneumoperitoneum is frequently observed. This study aimed to explore the clinical and the multi-slice computed tomography (MSCT) features of PCI with pneumoperitoneum in high-altitude regions to help prevent unnecessary laparotomies. Methods: A retrospective analysis was performed on the imaging and clinical data of 15 patients diagnosed with PCI and pneumoperitoneum. The clinical characteristics analyzed included age, gender, ethnicity, clinical symptoms, laboratory test results, and medical history. The imaging features analyzed included PCI lesion location, quantity, and extent of involvement. Results: PCI with pneumoperitoneum accounted for 33.7% of all pneumoperitoneum cases, and in all 15 patients, the site of occurrence was the colon. Of the 15 patients, 13 (86.7%) had multisegmental involvement, one had total colonic involvement, and two (2/15; 13.3%) had limited involvement. The ascending colon, hepatic flexure, and transverse colon were the most commonly involved. Conclusions: In high-altitude regions, the presence of PCI should be considered when MSCT reveals pneumoperitoneum. In cases of pneumoperitoneum caused by PCI, which does not typically require urgent surgery, MSCT clearly delineates the site and extent of lesion involvement, as well as any intestinal and extra-intestinal complications.