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Rare disease
CASE REPORT
Pneumatosis intestinalis in an adult patient with antral stenosis and midgut malrotation
  1. Mehrnaz Mehrkhu1,
  2. Iman Shirvani Dehkordi2,
  3. Pooya Shirvani Dehkordi2,
  4. Amir Shirvani Dehkordi3
  1. 1 Department of Medicine, Student Research Committee, Lorestan University of Medical Sciences, Faculty of Medicine, Khorramabad, Iran
  2. 2 Department of Veterinary Medicine, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
  3. 3 Department of Emergency Medicine, Emergency Medicine Research Center (Al-Zahra Research Institute), Isfahan University of Medical Sciences, Isfahan, Iran
  1. Correspondence to Dr Amir Shirvani Dehkordi, amirshirvani.md{at}gmail.com

Summary

Pneumatosisintestinalis (PI) is a radiological finding with about 0.03% incidence and incompletely understood pathogenesis. We report a case of PI with a rare presentation of pneumoperitoneum that underwent diagnostic surgery and finally diagnosed by midgut malrotation and antral stenosis. A 40-year-old man with 1-year history of dyspepsia and vomiting which was aggravated by 20 kg underweight since 3 months ago, despite medications was presented. His imaging examinations showed partial antral obstruction besides pneumoperitoneum and gas collection in the small intestine wall, which were in favour of PI. Samplings of the small intestine during laparotomy reported simple serosal cysts. Persistence of his symptoms forced him to recourse to another hospital and their new imaging revealed Ladds’ band in addition to mentioned findings in previous studies; he underwent subtotal gastrectomy plus Ladds’ band division by Braun gastrojejunostomy. PI could be a presentation of antral stenosis and midgut malrotation. PI with pneumoperitoneum needs surgical interventions. Considering that most of the midgut malrotation cases are diagnosed in the first year of life and it is very rare in adults, it may bethat these new findings are due to adhesion band formation after the first surgery in this case.

  • small intestine
  • endoscopy
  • stomach and duodenum
  • pathology
  • radiology

https://doi.org/10.1136/bcr-2017-223238

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    Footnotes

    • Contributors ASD is the corresponding author and contributing to conception and design, interpretation of lab findings and other data, drafting the manuscript and revising it, submission and giving the final approval of the revisions, encouraging ISD and PSD to investigate, supervising and agreement for the findings and all aspects of the work, approving the final version of manuscript. MM contributed to the conception of the research, conducting the study, revising the manuscript, approving the final version of the manuscript and agreement for all aspects of the work and acting as corresponding author. ISD and PSD contributed to the designing of the study model and working on almost all the technical details, collecting the acquisition data and sorting them, complying the literature sources and checking the references, writing some of the parts of the manuscript, providing critical feedbacks and helping to shape the research approving the final version of the manuscript and agreement for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.