A CASE OF PNEUMATOSIS CYSTOIDES INTESTINALIS PERFORMED LAPAROTOMY WITH A DIAGNOSIS OF INTESTNAL PERFORATION

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  • 消化管穿孔として開腹術を行った腸管嚢腫様気腫症の１例

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Abstract

Pneumatodes cystoides intestinalis is a disease that can be treated conservatively, if the correct diagnosis is made as far as serious clinical manifestations are absent. We report a case of pneumatosis cystoides intestinalis performed laparotomy with a diagnosis of intestinal perforation.<br>An 80-year-old woman was seen at the department of internal medicine in our hospital because of right lower abdominal pain. No abnormalities were shown on chest and abdominal x-ray films. Abdominal CT and ultrasonography revealed intraabdominal free air on the surface of the liver and thickening of the wall of the gut covering from the cecum to ascending colon. From these findings, peritonitis due to perforation of either colonic diverticulum or the appendix was suspected, and an emergency laparotomy was performed at the department. No recognizable perforation was seen in the gut, but numerous emphysematous changes and scattered elastic-hard indurations like submucosal tumors were palpated in the subserosal structure and mesentery of the ileum about 90cm proximal to the terminal ileum. At surgery, the ileum by about 25cm was resected. Histopathologically these cystic lesions were identified to be submucosal, and pneumatosis cystoides intestinalis was diagnosed. The patient's postoperative course was uneventful. There have been no signs of recurrence as of 8 months after the operation.

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