Case Report Primary Pneumatosis Intestinalis of Small Bowel: A Case of a Rare Disease Daniela Berritto, 1 Raffaello Crincoli, 2 Francesca Iacobellis, 1 Francesca Iasiello, 1 Nunzia Luisa Pizza, 1 Francesco Lassandro, 3 Lanfranco Musto, 4 and Roberto Grassi 1 1 Depatment of Radiology, Second University of Naples, P.za Miraglia 2, 80138 Napoli, Italy 2 Depatment of Radiology, Ospedale Landoi ASL, Solofra Indirizzo, Via Melito, 83029 Solofra, Italy 3 Depatment of Radiology, Azienda ospedaliera “V. MONALDI,” Via Leonardo Bianchi, 80131 Napoli, Italy 4 Depatment of Radiology, Ospedale Criscuoli. Via Quadrivio, Sant’Angelo dei Lombardi, 83054 Avellino, Italy Correspondence should be addressed to Daniela Berritto; berritto.daniela@gmail.com Received 13 August 2014; Accepted 25 October 2014; Published 17 November 2014 Academic Editor: Carmela De Crea Copyright © 2014 Daniela Berritto et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pneumatosis intestinalis (PI) is a condition in which multiple gas-illed cysts are located in the bowel wall; it can represent a wide spectrum of diseases and a variety of underlying diagnoses. he present report describes the case of an 86-year-old man with symptomatic primary PI of small bowel treated with surgical approach ater periodic episodes of cysts rupture and superimposed inlammation revealed on the basis of a clinical suspicion thanks to abdominal computed tomography. Moreover, ater one year of followup, there has been no recurrence of digestive symptoms. 1. Introduction Pneumatosis intestinalis (PI) is a inding characterized by the presence of gas within the bowel wall [1, 2]. Two main theories have been proposed in the medical literature. A mechanical theory hypothesizes that gas dissects into the bowel wall from either the intestinal lumen or the lungs via the mediastinum due to some mechanism causing increased pressure (i.e., bowel obstruction or emphysema). A bacterial theory proposes that gas-forming bacilli enter the submucosa through mucosal rents or increased mucosal permeability and produce gas within the bowel wall [3, 4]. PI has been classiied as primary (idiopathic) and sec- ondary. Primary PI (15%) is generally nonsymptomatic and diagnosis is oten occasional. his form is usually located in the colon. Males are more oten afected and the age group most afected is between the fourth and sixth decades of life [5]. Secondary PI (85%) has been associated with numerous coexisting disorders of the gastrointestinal tract or the res- piratory system, such as chronic obstructive pulmonary dis- ease, intestinal obstruction, ischemic bowel disease, necro- tizing enterocolitis in premature infants, immunodeiciency such as AIDS, bacterial and/or viral infection, and drug ther- apy [6–13]. Morphologically PI may occur in two diferent types: bubble-like (cysts in intestinal wall), typical of the primary type, and band-like (continuous lines), correlated with secondary PI [14, 15]. We present a rare case of idiopathic bubble like (cystoides) PI of the small bowel. 2. Case Report An 86-year-old man was admitted to the emergency depart- ment presenting with abdominal pain, subobstructive epi- sode, and constipation alternately to diarrhea. His previous medical history revealed a cholecystectomy. Abdominal examination at admission revealed a difuse distention and mild rebound tenderness. Laboratory studies revealed unremarkable serum blood count, electrolytes, and liver biochemistry. Abdominal computed tomography (CT) without intra- venous contrast demonstrated some gas-illed cysts within the small bowel wall, not associated with free intraperitoneal air. Based on the CT inding of air within the bowel wall, Hindawi Publishing Corporation Case Reports in Surgery Volume 2014, Article ID 350312, 4 pages http://dx.doi.org/10.1155/2014/350312