A Case Report of Pneumatosis Cystoides Intestinalis Associated with a Large Amount of Free Air in the Abdominal Cavity

Hitoshi Ishikawa, Yoshiaki Sasaki, Katsunao Nakagami, Jun Horiguchi, Syuuichirou Asaumi, Yukio Miyamoto*

Department of Surgery, Fujiyoshida Municipal Hospital
*Second Department of Surgery, Gunma University, School of Medicine

Pneumatosis cystoides intestinalis is uncommon, but sometimes presents as free air in the abdominal cavity and may require an emergency operation. We report a patient treated for pneumatosis cystoides intestinalis in the jejunum, in hom gastro-intestinal perforation was suspected before surgery. The patient as a 35-year-old man. His chief complaint was abdominal distension gradually increasing during about 20 days before admission. He consulted our department on June 19, 1989. Marked abdominal distension and free air in the abdominal cavity were revealed by X-ray. From these findings, gastro-intestinal perforation was suspected and an emergency laparotomy was performed. The operative findings are as follows: 1) 1600 ml of light yellow, clear serous ascitic fluid; 2) absence of perforation; 3) edematous thickening of the jejunal wall over 10 cm in length at approximately 50 cm from Treitz's ligament; 4) a number of vacuoles of various sizes in the subserosal layer of the jejunum and its mesentery. A diagnosis of pneumatosis cystoides intestinalis was made and the jejunum including the lesion was resected. The specimen showed a number of soft polypoid lesions about 5 mm in diameter in the mucosa. Histopathological examination revealed a number of cysts in the submucosa layer and these cysts were surrounded by granulomatous changes including polynuclear giant cells in the stroma. Moreover the inner surface of these cysts was covered by a lining of flat cells, and this was considered a case of "primary pneumatosis".

Key words
pneumatosis cystoides intestinalis, free air in the abdominal cavity

Reprint requests
Hitoshi Ishikawa Department of Surgery, Fujiyoshida Municipal Hospital
2-8-1 Midorigaoka, Fujiyoshida, 403 JAPAN

Accepted
March 7, 1990

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