P2480 - Pneumatosis Cystoides Intestinalis in the Setting of a Bronchoperitoneal Fistula: A Rare Clinical Entity

Idan Grossmann, MD¹, Aubin Attila, MD², Anasuya Brahmamdam, MD², Jaimin Dudhia, MD², Harshavardhan Sanekommu, MD², William Sebastian, MD², Stuart Campbell, MD², Yaser Salah, ³, Allyson Whitsett, ³, Xheneta Demiri, ³, Kevin Callagay, ³, Vera Hapshy, DO⁴, Lee Peng, MD, PhD², Natasha Campbell, MD², Sameh Girgis, MD², Angelo Chinnici, MD², Mohammad Hossain, MD²
1Hackensack Meridian Health, Bradley Beach, NJ; 2Hackensack Meridian Health, Neptune, NJ; 3St. George's University, Neptune, NJ; 4Hackensack Meridian JSUMC, Neptune City, NJ

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of gas-filled cysts within the wall of the gastrointestinal tract. Clinical manifestations range from asymptomatic to symptoms such as abdominal pain, distention, or diarrhea.
PCI may be idiopathic or secondary to a variety of conditions, including gastrointestinal disorders or prior abdominal surgeries.
We report an exceedingly rare case of a 76-year-old female with a history of hiatal hernia repair who was incidentally found to have air-filled cystic structures within the bowel wall, consistent with PCI, secondary to a rare bronchoperitoneal fistula.

Case Description/

Methods: A 76-year-old female with a past medical history of hypertension, type 2 diabetes mellitus, HFrEF, sick sinus syndrome status post pacemaker, and hiatal hernia status post repair 5 years ago presented with new-onset hematuria.
3 months earlier, she had been hospitalized for an abnormal cardiac rhythm and underwent pacemaker implantation.
At that time, she was incidentally found to have a pneumoperitoneum without any associated symptoms. She subsequently underwent a diagnostic laparotomy and endoscopy which did not reveal any evidence of bowel perforation.
The patient also reported a one-year history of intermittent fecal incontinence, characterized by loose, watery, brown bowel movements with excessive flatulence.
On admission, the patient was alert and oriented to person, place, and time, and appeared in no acute distress.
Vital signs were stable. Physical examination revealed a soft non-tender abdomen mildly distended without rigidity or guarding.
Laboratory results with a creatinine level of 1.19 mg/dL from a normal baseline.
A CT scan obtained to evaluate hematuria revealed worsening pneumoperitoneum with PCI with multiple air-filled cystic structures within the submucosal layer of the bowel wall.
A prior operative report noted a halothane-like odor during the laparotomy, raising suspicion for a fistula, which was confirmed in a V/Q scan as a bronchoperitoneal fistula.

Discussion: PCI is an uncommon condition that poses a diagnostic challenge due to its variable clinical presentations. While PCI is generally benign and uncomplicated, the identification of a fistula shifts the differential toward a secondary and complicated process.
This case highlights a rare and diagnostically challenging scenario that can significantly impact a patient’s quality of life and in some cases can lead to severe complications.


Figure: Pneumatosis Cystoides Intestinalis: air-filled cysts in the wall of the transverse colon.




Figure: Diffuse Pneumoperitoneum

Disclosures:
Idan Grossmann indicated no relevant financial relationships.
Aubin Attila indicated no relevant financial relationships.
Anasuya Brahmamdam indicated no relevant financial relationships.
Jaimin Dudhia indicated no relevant financial relationships.
Harshavardhan Sanekommu indicated no relevant financial relationships.
William Sebastian indicated no relevant financial relationships.
Stuart Campbell indicated no relevant financial relationships.
Yaser Salah indicated no relevant financial relationships.
Allyson Whitsett indicated no relevant financial relationships.
Xheneta Demiri indicated no relevant financial relationships.
Kevin Callagay indicated no relevant financial relationships.
Vera Hapshy indicated no relevant financial relationships.
Lee Peng indicated no relevant financial relationships.
Natasha Campbell indicated no relevant financial relationships.
Sameh Girgis indicated no relevant financial relationships.
Angelo Chinnici indicated no relevant financial relationships.
Mohammad Hossain indicated no relevant financial relationships.

Idan Grossmann, MD¹, Aubin Attila, MD², Anasuya Brahmamdam, MD², Jaimin Dudhia, MD², Harshavardhan Sanekommu, MD², William Sebastian, MD², Stuart Campbell, MD², Yaser Salah, ³, Allyson Whitsett, ³, Xheneta Demiri, ³, Kevin Callagay, ³, Vera Hapshy, DO⁴, Lee Peng, MD, PhD², Natasha Campbell, MD², Sameh Girgis, MD², Angelo Chinnici, MD², Mohammad Hossain, MD². P2480 - Pneumatosis Cystoides Intestinalis in the Setting of a Bronchoperitoneal Fistula: A Rare Clinical Entity, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.