Conclusions and Results (outcome and follow-up)
Pathologic findings of the specimens are summarized below:
- Diaphragmatic masses (Figure 4):
- Specimen A (Figure 4A): 2.5 x 1.7 x 1.1 cm of partially cystic
necrotic tissue surrounded by a thin rim of viable hyalinized
fibrocollagenous tissue, consistent with infarct
- Specimen B (Figure 4B): 3.8 x 2.7 x 2.5 cm cyst with a rim of
moderately cellular fibrocollagenous tissue, consistent with
focal pneumatosis cystoides
- Bowel resection (Figure 5B):
- Fragments of terminal ileum, margins unremarkable, no evidence of
necrosis, minimal loss of villi
- Grossly spongy areas: composed of complex interlacing cysts lined by
polygonal histiocytes, occasionally pseudostratified
- Cystic change was largely subserosal but also involved the
muscularis propria and mucosa.
- Stroma: composed of modestly cellular myxoid fibrocollagenous tissue
with admixed round inflammatory cells
- Central serosal surface contained a multicystic mass (14.0 x 10.0 x
1.5 cm), with subcentimeter watery-fluid containing cysts.
- Thick, turbid, yellow, purulent material was revealed at the
antimesenteric aspect.
- Final pathologic diagnosis: segmental pneumatosis cystoides
intestinalis
- Peritoneal fluid analysis:
- Abundant acute and chronic inflammation in a background of reactive
mesothelial cells and histiocytes
- Negative for infection or malignancy
The patient remained stable post-operatively. On postoperative days 1-3
he was on a nothing-by-mouth (NPO) diet, had bilious nasogastric (NG)
tube output, and required ketamine for pain control. He started a 4-day
course of piperacillin/tazobactam and fluconazole. By postoperative day
4, his pain improved, a clear liquid diet was started, and the NG tube
was removed. He was discharged on postoperative day 5.
Several weeks after discharge, the patient was hospitalized at another
facility for continued symptoms. The patient reported undergoing a
magnetic resonance (MR) enterography at that time which was
unremarkable. Additionally, the patient reported undergoing a repeat
colonoscopy in April of 2024 with no significant findings. In June of
2024, the patient reported that, symptomatically, he had minimal acid
reflux, bloating, and abdominal distention/pain that were
well-controlled by limiting caloric intake. His weight remained stable
despite limiting his diet. A chronological timeline of events of this
case is outlined in Figure 6.