A Case of Pneumatosis Cystoides Intestinalis with Intra-Abdominal Free Air and Hepatic Portal Venous Gas

Hideki Isobe, Makoto Takiguchi, Takuya Miura, Toshiyuki Moriya, Ken-ichi Hayashi, Yukio Inaba and Syuichi Watabe

Department of Surgery, Yamagata Prefectural Kahoku Hospital

A 70-year-old woman bedridden due to cerebral infarction sequela and admitted for abdominal pain and distention had a blood pressure of 83/33 mmHg, a heart rate of 88 beats/min, and a body temperature was 35.0°C. Physical examination showed abdominal distension and tenderness, but no peritoneal irritability. Biochemical blood examination showed increased white blood cell (WBC) and C reactive protein (CRP). Abdominal X-ray showed free air. Abdominal CT indicated ascites, hepatic portal venous gas, thickened intestinal wall, and pneumatosis cystoideus intestinalis in the wall of the small intestine. Suspected intestinal perforation due to intestinal necrosis and diffuse peritonitis necessitated emergency laparotomy. Intra-abdominal inspection showed neither intestinal necrosis nor perforation. Following intra-abdominal lavage, cecostomy, jejunostomy, and gastrostomy, nutrition was recovered using enteral nutrition, and she was discharged on postoperative day 94. In this case, we suspected increased intraluminal intestinal pressure due to constipation caused pneumatosis cystoides intestinalis and hepatic portal venous gas through mucosal disruption. Microperforation of the serosa was thought to cause intraabdominal free air.

Key words
pneumatosis cystoides intestinalis, portal venous gas, intra-abdominal free air

Reprint requests
Hideki Isobe Department of Surgery, Yamagata Prefectural Kahoku Hospital
111 Gassando, Yachi, Kahoku-cyo, Nishimurayama-gun, 999-3511 JAPAN

Accepted
December 19, 2007

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