A Case of Pneumatosis Cystoides Intestinalis with Chronic Idiopathic Intestinal Pseudoobstruction

Taku Kitayama, Tetsuyuki Uchiyama, Tomoya Abe, Tatsuya Ueno¹⁾, Masaru Ohnuma¹⁾, Chikashi Shibata²⁾, Hideo Ise and Mika Watanabe³⁾

Department of Surgery, Ishinomaki Municipal Hospital
Department of Surgery, Miyagi South Prefecture Central Hospital¹⁾
Division of Biological Regulation and Oncology, Department of Surgery²⁾ and Department of Pathology³⁾, Tohoku University Hospital

A 23-years-old man diagnosed in childhood as having chronic idiopathic intestinal pseudoobstruction (CIIP) and admitted for abdominal fullness and weight loss in December 2005. He underwent conservative therapy with total parenteral nutrition (TPN). In August 2006, his high fever and abdominal fullness became aggravated, suggesting acute peritonitis. Abdominal X ray imaging showed on enlarged intestine and subphrenic free air, but not peritonitis irritation. He was eventually diagnosed with pneumatosis cystoides intestinalis (PCI) with CIIP. Abdominal contrast-enhanced computed tomography (CT) showed no ascites, but indicated a double-layered structure at the small intestinal wall. Ten days after long-tube suction, enhanced CT showed that free air had decreased and PCI had disappeared. Emergency surgery was previously recommended for intestinal obstruction accompanied by free air with PCI because of suspected intestinal perforation. Our case suggests that surgical decision-making be done more circumspectly.

Key words
diffuse peritonitis, CIIP, PCI

Reprint requests
Tetsuyuki Uchiyama Department of Surgery, Ishinomaki Municipal Hospital
1-7-20 Minamihama-machi, Ishinomaki, 986-0835 JAPAN

Accepted
December 16, 2009

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