Sleeve Gastrectomy in Case of Pneumatosis Intestinalis

Bariatric surgery video case: pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. Intramural gas can also affect the stomach, but this condition is referred to as gastric pneumatosis. Since its first description, PI has appeared in the literature under many names, including pneumatosis cystoides intestinalis, intramural gas, pneumatosis coli, pseudolipomatosis, intestinal emphysema, bullous emphysema of the intestine, and lymphopneumatosis. PI can also be associated with pneumoperitoneum or free air in the peritoneal cavity. The pathogenesis of PI is poorly understood and is probably multifactorial. In some cases, PI is an incidental finding associated with a benign etiology. The incidence of pneumatosis intestinalis (PI) is difficult to ascertain since most patients are asymptomatic and never come to clinical attention. Adults are typically diagnosed in the fifth to eighth decade. Pneumatosis intestinalis occurs in approximately 0.03% of the population. Given the asymptomatic course of the majority of cases, the exact prevalence of the condition is unknown, and that 0.03% is possibly an underestimation. It can affect any age group, although it is more prevalent in older populations than in young adults and infants.  In this clinical video, we present a case of pneumatosis intestinalis localized on splenic flexure as an incidentally finding during sleeve gastrectomy.