Acute abdomen with gastric volvulus revealing an underlying pneumatosis cystoides intestinalis: a case report.

BACKGROUND: Pneumatosis intestinalis is an abnormal presence of free air outside the lumen of the intestines in many shapes. It is classified based on its etiology to primary or secondary, it affects adults as well as infants and can involve any part of the GI tract. CASE PRESENTATION: We report a case of a 55-year-old man with a past medical history of a surgically repaired perforated duodenal ulcer who presented with an acute abdominal pain, Flatulence and constipation. On examination of the abdomen; severe distension, tenderness and tympanicity on percussion were noted. An erect CXR was performed and showed bilateral sub-diaphragmatic air levels. We performed an abdominal Paracentesis under the right subcostal margin which led to evacuation of large amounts of air. Next, an investigational laparotomy showed that the reason was a gastric volvulus associated with an anterior and posterior gastric wall lacerations. The suitable surgical repair approach was taken, but another lesion was detected incidentally. A pneumatosis cystoides intestinalis (PCI) was extended along large length of the intestines in many shapes and without any symptoms or signs. CONCLUSIONS: Pneumatosis cystoides intestinalis has been reported continuously in relation to peptic ulcer disease (PUD). We aim to report a new association of a gastric volvulus and PCI secondary to pyloric stenosis caused by a duodenal ulcer; which we believe can aid in the diagnosing of dangerous complications, of a rare disease.

Adult Hirschprung's disease diagnosed postoperatively: A case report.

Background: Hirschprung's Disease (HD) is a congenital disease where the ganglion cells that innervate the colon fail to migrate. Most cases are diagnosed during childhood, however, in rare cases it can go unnoticed until adulthood. Case presentation: We present a case of a 40-year-old-man who had been managing his chronic constipation with an atypical diet, until he was diagnosed with HD following an emergent abdominal surgery due to unresolved constipation. His diagnosis was delayed mainly out of fear of medical procedures. The surgery was later complicated and followed by a second and a final third and definitive surgery, suitable for the diagnosis of HD. Conclusion: HD should be included in the differential diagnosis of constipation even in this age. Also, patient awareness should be increased to ensure better quality of life.