Perforated PUD associated with pneumatosis intestinalis: A case report

Abstract

INTRODUCTION AND IMPORTANCE: Perforated peptic ulcer disease (PUD) represents a serious complication of PUD. Its association with pneumatosis intestinalis (PI) is exceedingly rare. PI is identified by the presence of gas within the bowel wall. The clinical presentation and management of PI are contingent upon the underlying causes. CASE PRESENTATION: We present the case of a 45-year-old male patient who arrived with a one-day history of abdominal pain. His vital signs were stable upon examination. During the abdominal assessment, findings included guarding and rigidity throughout the abdomen. The patient underwent laparotomy, which revealed a perforation in the first part of the duodenum and multiple air-filled cystic lesions on the small bowel. A duodenal repair, along with resection and anastomosis of the small bowel, was performed. The patient experienced a smooth postoperative recovery and has shown positive progress at the one-year follow-up. CLINICAL DISCUSSION: Perforated peptic ulcer disease (PUD) is a frequent reason for surgical admission. It typically presents as acute abdominal pain; however, its association with pneumatosis intestinalis (PI) is quite rare. PI, characterized by the presence of gas in the bowel wall, is an uncommon condition that can be classified as either primary (idiopathic), which occurs without any identifiable underlying condition or secondary, which occurs as a result of another medical condition. Diagnosis may be confirmed through imaging or during surgery, and histological evaluation is rarely necessary. The clinical presentation of PI can vary significantly. Management strategies depend on the classification of the condition: surgery is seldom required for idiopathic or benign secondary PI, whereas more severe cases of secondary PI usually necessitate surgical intervention. CONCLUSION: Although rare, pneumatosis intestinalis can occur in association with perforated peptic ulcer disease (PUD). Managing the underlying cause of the secondary pneumatosis does not require additional treatment.