The Use of Underwent Laparoscopy for Diagnosis and Treatment of Pneumatosis Cystoides Intestinalis: A Case Report

Takashi Hisamatsu, Atsushi Nanashima^**, Kouichi Izumikawa^*, Hideaki Haga^*, Tomoichirou Hayakawa^*, Kouhei Hara^* and Kinichi Izumikawa^*

Department of Surgery, Izumikawa Hospital
Department of Internal Medicine, Izumikawa Hospital^*
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences^**

A 76-year old man with a history of chronic viral hepatitis and obstinate constipation was admitted to our hospital with severe abdominal distension. The patient had no remarkable abdominal pain or signs of any inflammatory disorders. An abdominal X-ray film showed massive intra-abdominal free-air, but no signs of ulceration or perforation were found in an upper GI series. However, a 3 cm multi-cystic lesion was found in the lower intestines, protruding into the abdominal cavity next to the site of the massive free-air, ascites observed on CT images. Pneumatosis cystoides intestinalis (PCI) was thought to be the most probable diagnosis, and an emergency laparoscopy was performed to rule out the possibility of intestinal perforation and relieve the patient's symptoms. A laparoscopy examination revealed multiple cystic lesions in the terminal ileum, ascites, and a liver with the appearance of chronic hepatitis; no evidence of intestinal perforation was seen even in the area of the multiple cystic lesions. Other PCI in the colon was observed by postoperative colonoscopy. The patient recovered without any complications. Although conservative therapy has been described as a common initial treatment for patients with PCI, our experience suggests that performing a laparoscopy examination may be useful not only for confirming the diagnosis, but for reducing the massive pneumoperitoneum resulting from severe constipation in patients with PCI.

Key words
laparoscopy, Pneumatosis cystoids intestinalis, massive free-air

Reprint requests
Atsushi Nanashima Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences 1-7-1 Sakamoto, Nagasaki, 852-8501 JAPAN

Accepted
May 27, 2003

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