A Case of Pneumatosis Cystoides Intestinalis with Intraperitoneal Free Air and Portal Vein Gas

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  • KITAGAWA Koichi
    Department of Surgery and Gastroenterology, Nishi-Yokohama International General Hospital Department of Surgical Gastroenterology, Tokyo Women's Medical University
  • ISHIZUKA Naoki
    Department of Surgery and Gastroenterology, Nishi-Yokohama International General Hospital
  • RYU Masamine
    Department of Surgery and Gastroenterology, Nishi-Yokohama International General Hospital
  • KOMATSU Eiji
    Department of Surgery and Gastroenterology, Nishi-Yokohama International General Hospital
  • YAMAMOTO Masakazu
    Department of Surgical Gastroenterology, Tokyo Women's Medical University

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Other Title
  • 保存的に治療したfree air と門脈ガスを伴う小腸腸管嚢腫様気腫症の1例
  • 症例 保存的に治療したfree airと門脈ガスを伴う小腸腸管囊腫様気腫症の1例
  • ショウレイ ホゾンテキ ニ チリョウ シタ free air ト モンミャク ガス オ トモナウ ショウチョウ チョウカンノウ シュ ヨウキシュショウ ノ 1レイ

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In August 2012 an 81-year-old man with a history of dementia, hypertension, sequelae of cerebral infarction, and a right foot amputation secondary to arteriosclerosis obliterans was admitted for unremitting hematochezia and vomiting. His whole abdomen was tender, but there was no evidence of peritonitis. Abdominal contrast-enhanced computed tomography (CT) showed evidence of pneumatosis at the small intestinal wall, free intraperitoneal air, and portal vein gas (PVG). Under a diagnosis of pneumatosis cystoides intestinalis (PCI) conservative therapy was initiated because the abdominal tenderness was mild, the amount of PVG was small, and the pneumatosis was located within the small intestine. Furthermore, obtaining informed consent from his family for other therapy was difficult. Fourteen days after conservative therapy was started, enhanced CT showed that the free intraperitoneal air, the PVG, and the pneumatosis had disappeared. In some cases of PCI with symptoms of intestinal necrosis or perforation such as intraperitoneal free air or PVG, emergency surgery might be required. However, our case suggests that surgical intervention can be more circumspect in patients with PCI localized within the small intestine.

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