Pneumatosis Intestinalis after Correction of Postinfarction VSD

Case Report

Austin Surg Case Rep. 2019; 4(1): 1029.

Pneumatosis Intestinalis after Correction of Postinfarction VSD

Yong Ko T and Ho Cho S*

Department of Thoracic and Cardiovascular Surgery, Kosin Gospel Hospital, Busan, Korea

*Corresponding author: Seong Ho Cho, Department of Thoracic and Cardiovascular Surgery, Kosin Gospel Hospital, Busan, Korea

Received: August 17, 2019; Accepted: September 17, 2019; Published: September 24, 2019


Pneumatosis Intestinalis (PI) refers to the phenomenon in which air is present in the bowel wall. It can be mistaken for ileus, which frequently occurs after general anesthesia due to abdominal distention. Delays in proper diagnosis and treatment can cause fatal results. Depending on a patient’s underlying disease, PI can occur at any age, and its incidence in the general population has been reported as 3 per 10,000 persons. The bowel wall air can affect a various amount of intestine, and it can be accompanied by pneumoperitoneum, pneumoretroperitoneum and portal venous gas inclusion. In this report, we present a case of fatal PI after correction of a postinfarction VSD.


Pneumatosis Intestinalis (PI) is defined as the accumulation of gas in the bowel wall. This unique image finding was first discovered by Du Vernoi in 1730 during cadaver dissection [1]. The incidence of pneumatosis intestinalis is increasing because of the improvements in and the use of radiographic abdominal studies, such as abdominal CT. In addition, many medical procedures including surgery, medications, and diagnostic procedures have contributed to the increase in PI. Based on autopsy studies, the incidence of PI in the general population has been estimated as 3 per 10,000 individuals [2]. PI can be a fatal disease, especially when combined with ischemic colitis which necessitates surgical intervention. When PI occurs immediately after surgery, it is sometimes difficult to distinguish from postoperative ileus. If a patient shows symptoms of ileus and infection after surgery, physicians must consider PI in the differential diagnosis.

Case Presentation

A 82-year-old woman visited a local medical center for chest pain and dyspnea which began 5 days prior to presentation. Coronary arteriography revealed a total occlusive lesion from the mid LAD. PCI was immediately attempted for revascularization but failed. Transesophageal echocardiography demonstrated a ventricular septal defect in the mid portion of interventricular septum, and the patient was transferred to our hospital for surgical intervention. At the time of admission, the chest pain, described as squeezing, persisted. The patient’s past medical history was notable only for hypertension. On physical examination, a cardiac murmur was prominent, and ST elevation was observed in the V2 ~ 5 lead on initial ECG. Laboratory examinations revealed increased cardiac enzymes: troponin-I level was 660 ng/L, and pro-BNP level was › 35,000 pg/ml. A chest x-ray demonstrated cardiomegaly and pulmonary edema. The patient received oxygen, aspirin, heparin, inotropics, and diuretics to treat IHD and HF. After two-lumen right subclavian catheterization for hemodialysis, the patient underwent surgery for VSD. Ventriculotomy was performed at the left lateral 2 cm of the mLAD, and the interventricular septal defect was observed. The VSD was first closed with bovine pericardium, sutured to normal tissue using pledget buttressed 3-0 Prolene. Another bovine pericardium was then sutured to the repaired VSD using 3-0 Prolene with running sutures for reinforcement, thus concluding the operation.

After surgery, the patient was noted to have persistent thrombocytopenia and low cardiac output. Insertion of an IABP was attempted through both femoral arteries but failed. As the treatments for IHD and CHF continued, the patient improved and was transferred to the general ward. However, on POD 4, she complained of dyspnea with cold sweats and was readmitted to the ICU for unstable V/S and low oxygen saturation. In the ICU, her HS-CRP, D-dimer, and BUN/Cr continuously increased, and her abdominal distension was severe. On postoperative day six, an enhanced abdominal CT scan revealed severe jejunal distension and an air bubble in the jejunum wall, resulting in the diagnosis of pneumatosis intestinalis (Figure 1 and 2). A small bowel infarction was suspected as the cause of the patient’s pneumatosis intestinalis and sepsis, so we recommended diagnostic and therapeutic laparotomy. However, the patient’s family refused surgery due to her age, and she expired on POD 7.

Citation: Yong Ko T and Ho Cho S. Pneumatosis Intestinalis after Correction of Postinfarction VSD. Austin Surg Case Rep. 2019; 4(1): 1029.