INTESTINAL PNEUMATOSIS CYSTOIDES ASSOCIATED WITH SMALL BOWEL VOLVULUS: A RARE CAUSE OF PNEUMOPERITONEUM IN A COPD PATIENT

We report the case of a 62-year-old male with a history of chronic obstructive pulmonary disease (COPD) and long-term tobacco use, admitted for persistent vomiting and cessation of bowel movements. Clinical examination revealed a stable, afebrile, and conscious patient with a soft, non-tender abdomen. Laboratory results demonstrated leukocytosis (19,800/mm3), elevated C-reactive protein (52.1 mg/L), and hypokalemia (2.59 mmol/L). Abdominal computed tomography (CT) showed small bowel distension up to 45 mm, a mesenteric whirlpool sign in the right iliac fossa, adjacent lymph nodes, and a large pneumoperitoneum. Surgical exploration revealed intestinal pneumatosis cystoides associated with small bowel volvulus, confirming the cause of the pneumoperitoneum. This case highlights the diagnostic challenge of differentiating benign from life-threatening causes of pneumatosis intestinalis and underlines the importance of prompt surgical management.