Segmentary Pneumatosis Coli in a Patient With Acute Abdomen

The patient is a 74-year-old woman with mild abdominal discomfort during the previous 2–3 weeks and chronic constipation, who presented abdominal pain that had been increasing over the previous 5 h, with no defined focus. Lab work showed leukocytosis with neutrophilia, increased C-reactive protein and procalcitonin and respiratory alkalosis. Pneumatosis coli was evident in the sigmoid colon on abdominal X-ray. Computed tomography confirmed segmental pneumatosis in the sigmoid colon, with no signs of acute diverticulitis (Fig. 1). Considering the patient's symptoms, we decided to perform urgent exploratory laparotomy.

Fig. 1

During surgical exploration, we observed the sigmoid colon had a normal consistency with no signs of ischemia, but there was segmental pneumatosis (Fig. 2). We found a limited amount of serous fluid in the pelvis, with negative microbiological cultures. Given the absence of other findings, we decided to perform a lavage of the abdominal cavity and leave a drain tube in the left paracolic gutter. The patient progressed favorably and was discharged on the 4th day post-op, without further treatment.

Fig. 2