A Case of Pneumatosis Cystoides Intestinalis with Paralytic Ileus

Yuki Sekine, Naoko Takatsu, Taichi Fukuzawa, Masaaki Kawai, Kazuyuki Kusuda, Yu Suzuki, Yoshihiro Endo and Michihiko Kitamura

Department of Surgery, Iwate Prefectural Isawa Hospital

A 67-year-old man with a history of diabetes mellitus, hypertension, and schizophrenia admitted for nausea and anorexia was found in physical examination to have severe abdominal distension without tenderness. Laboratory data was as follows: white blood cell count 8,300/mm³, CRP (C reactive protein) 12 mg/dl, serous creatinin 2.4 mg/dl, and serum blood sugar 324 mg/dl. Abdominal radiography showed free air and dilated small intestinal gas, and abdominal computed tomography showed free air and emphysema in the wall of the dilated intestine and the mesenterium. In emergency laparotomy, diffuse emphysema was noted in the wall of the anal side of the small intestine and the mesenterium. We judged these emphysematous changes occured due to increased internal intestinal pressure. An ileus tube was emplaced after drainage of intestinal juice. The postoperative course was uneventful. Pneumatosis cystoides intestinalis is a rare disease forming multiple cystic emphysema in the wall of the intestine. Causes of this disease are considered to include increased internal intestinal pressure, intestinal ischemia, inflammation, rupture of emphysematous change of the lung in chronic pulmonary diseases, and some drugs. Conservative therapy usually is chosen, but in cases with severe inflammatory and/or ischemic findings, emergency surgery is indicated. In our case, we conducted emergency surgery due to the inflammatory reaction, increased creatinin, and caring underestimation of abdominal findings masked by schizophrenia and diabetes mellitus.

Key words
pneumatosis cystoides intestinalis, free air, ileus

Reprint requests
Yuki Sekine Department of Surgery, Iwate Prefectural Isawa Hospital 61 Aza Ryugababa, Mizusawa-city, 023-0864 JAPAN

Accepted
September 25, 2002

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