Large bowel pneumatosis intestinalis: to operate or not to operate?

A 72-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and hepatitis B, presented to the emergency room, with abdominal pain that had started 6 h previously, accompanied by nausea, vomiting and a 38.8°C fever. Clinical examination revealed generalised peritonitis. Lab results showed increased C reactive protein at 66 mg/L (normal value <7.5) and leukocytosis at 21.6 giga/L (normal value 4.0–10.0). Abdominal X-ray showed signs of colic pneumatosis (figure 1). This was confirmed by CT scan, which also showed the existence of a discreet pneumoperitoneum and the presence …