Colocolic intussusception secondary to pneumatosis cystoides intestinalis: the role of abdominal radiography in the diagnosis

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A previously healthy adolescent girl presented to the emergency department with intermittent, periumbilical pain of 3 days’ duration. Her visit was prompted by exacerbation and increasing frequency of the pain. She denied other symptoms, such as vomiting, diarrhoea and bloody stool as well as a history of surgery, trauma and recent consumption of raw food. Her vital signs were normal, and a physical examination revealed pain on compressing the periumbilical area. There were no peritoneal signs. The intestines were not able to be clearly visualised on abdominal ultrasound. Abdominal radiography revealed multiple, round lucencies distributed in a crescentlike pattern in the left upper quadrant and absence of air in the right side of the abdomen (figure 1). Noncontrast abdominal CT revealed colocolic intussusception with multiple, intramural, airfilled cysts at the lead point within the transverse colon (figure 2). Based on these findings, intussusception secondary to pneumatosis cystoides intestinalis (PCI) was diagnosed. The patient successfully underwent radiological hydrostatic reduction. An abdominal radiograph taken 7 hours after the reduction revealed multiple, colonic cysts mainly in the caecum (figure 3). At the 3month followup, the PCI was no longer visible on an abdominal radiograph. PCI is intestinal intramural airfilled cysts, most often developing in patients in their 40–50s. Although the majority of PCI develops secondary to other intestinal or pulmonary diseases, around 15% of them develops in patients without any background medical conditions. Although CT showed high sensitivity in detecting PCI, diagnosis is often delayed due to its nonspecific symptoms. Intussusception, or the invagination of a part of the intestine (the intussusceptum) into the adjacent part (the intussuscipiens), is a common abdominal emergency in children. It is usually diagnosed by