Sudden Onset of Sigmoid Volvulus in a Patient with Pneumatosis Intestinalis Associated with Tuberculous Peritonitis and Redundant Sigmoid Colon:A Case Report

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare gastrointestinal disorder defined by multiple air-filled cysts, either submucosal or subserosal, often accompanied by inflammation and fibrosis. Case Presentation: This case report discusses the case of a 67-year-old male patient who presented with intermittent diarrhoea for one year. Past medical history was significant for tuberculous peritonitis, diabetes, and hypertension, with no relevant positive family history. Faecal occult blood and tuberculosis T-spot were positive. Chest and abdominal CT showed a small cavity in the right lung apex, slight fluid in the pelvic and abdominal cavities, thickening of the peritoneum, cystic gas shadows within the submucosa, and a long sigmoid colon. The patient was diagnosed with tuberculous peritonitis, sigmoid colon redundancy, and PCI; he was treated with anti-tubercular therapy and was under regular observation. After a year of treatment, the patient experienced a sudden cessation of gas and bowel movements for 4 days, with no obvious constipation. Abdominal CT showed free pneumoperitoneum and sigmoid volvulus with proximal colon obstruction. A complete barium enema showed a long and tortuous sigmoid colon. Finally, the patient was diagnosed with sigmoid volvulus and PCI. The patient was managed with fluid and electrolyte replacement, parenteral nutrition, and gastrointestinal decompression, followed by a laparoscopic sigmoidectomy with proximal colostomy. He was followed up and found to recover well post-discharge, and has since remained asymptomatic. Conclusion: Patients with PCI present with non-specific symptoms or can be asymptomatic. This case highlights the need to accurately diagnose and promptly treat this condition, as misdiagnosis or neglect can result in severe complications, such as intestinal perforation and obstruction.