Images in Clinical Medicine
Pneumatosis Coli and Colonic Intussusception
N Engl J Med 2001; 345:964September 27, 2001
- Article
Figure 1 A 32-year-old man with no clinically significant medical history presented to the emergency room with fever and a 12-hour history of pain in the right upper quadrant. Before the onset of discomfort he had run 5 miles (8 km) and performed 200 sit-ups. Abdominal examination revealed 1+ tenderness in the right upper quadrant. Laboratory evaluation revealed a total bilirubin level of 1.1 mg per deciliter (18.8 μmol per liter), an aspartate aminotransferase level of 25 U per liter, an alanine aminotransferase level of 36 U per liter, an alkaline phosphatase level of 62 U per liter, a white-cell count of 8400 per cubic millimeter, and a hematocrit of 42 percent. A plain film of the abdomen (Panel A) disclosed multiple air-filled lucencies in the right upper quadrant that were suggestive of the presence of pneumatosis coli. A computed tomographic scan revealed air within the wall of the ascending colon and the typical target lesion of a colonic intussusception (arrow in Panel B). The intussusception was reduced with air and barium. The patient was asymptomatic when he left the emergency room. Two weeks later a colonoscopy revealed numerous pseudopolyps in the ascending colon in the same location as the pneumatosis seen on the plain film. No other lesions were noted, and the results of mucosal biopsies were normal. We presumed that the pneumatosis coli represented the point at which the intussusception began. The patient had no further symptoms, and a plain film obtained two months later showed no change in the air-filled lucencies.
Mark A. Stern, M.D.
Dekalb Gastroenterology Associates, Atlanta, GA 30033William D. Chey, M.D.
University of Michigan Medical Center, Ann Arbor, MI 48109- Citing Articles (1)
Citing Articles
1
Kunio Takeuchi, Yasushi Tsuzuki, Tetsu Ando, Masao Sekihara, Takashi Hara, Takayuki Kori, Hiroyuki Kuwano. (2003) The Diagnosis and Treatment of Adult Intussusception. Journal of Clinical Gastroenterology 36:1, 18-21
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