Tsung-Jung Tsai and Yu-Yao Chang
Purpose: Pneumatosis Cystoides Intestinalis (PCI) can be innocuous or fatal. Distinguishing pathologic etiology from benign is problematic. Physicians must cumulatively evaluate patient’s vital signs, clinical signs and symptoms, lab data and radiographic image to reach a management plan.
Methods: We present a case of an 83-year-old man with presentation of abdominal pain. We provided a review of the clinical manifestations, imaging data of this case, and the literature related to the PCI.
Results: A male patient had a history of cecum adenoma post with laparoscopic assisted right hemicolectomy 13 years ago, recurrent interstitial pneumonitis related to Nivolumab under methylprednisolone 4 mg use, and diabetes under acarbose control. This patient was admitted to the emergency department with right upper quadrant abdominal pain. A Computed Tomography (CT) scan showed PCI and ischemic colitis. Emergent explore laparotomy was performed and subtotal colectomy and small bowel resection due to incidental bowel ischemia under Indocyanine Green (ICG) image. Patient’s condition continued to deteriorate and expired on post-operative day 81.
Conclusion: For acute abdomen or sepsis condition, operation should be arranged due to suspicion of ischemia or necrosis. Laparoscopy can be considered if certain risk factors are presence. If ischemic colon is noted, small intestine should be assessed carefully, especially the ileum, due to higher possibility of small intestinal pathologic PCI.
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