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An unexpected cause of constipation and abdominal distension in COPD

Journal Volume 85 - 2022
Issue Fasc.3 - Clinical images
Author(s) M. De Smet 1 2, E. Derom 1 2, G. Joos 1 2
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Full Article
PAGES 537-539
(1) Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
(2) Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium

Question: A 62-year old man presented to our tertiary care hospital for a second opinion regarding end stage COPD GOLD 4D. He had a medical history of former alcohol use complicated by liver steatosis and former smoking. Upon admission the patient complained of constipation and abdominal distension. Physical examination showed diffuse hypertympanic percussion and diffuse abdominal pain upon palpation without signs of peritoneal irrita- tion. CRP, hemoglobin, lactate, liver enzymes, and serum creatinine were within limits of normal. Abdominal radiography showed dilatation of the colon transversum with intramural and intra-abdominal free air (Figure 1). Contrast-enhanced abdominal CT showed extensive intramural air in the right hemicolon (Figure 2).

Answer: The findings are consistent with pneumatosis intestinalis (PI). Conservative management with oxygen, triple bronchodilator therapy, fasting, laxation and antibiotic therapy resulted in resolution of the clinical symptoms.

The authors declare that they have no conflict of interest.
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