Segmental pneumatosis cystoides coli: Computed tomography-facilitated diagnosis

Abstract

Background: Intestinal pneumatosis is a rare entity of unclear etiopathogenesis characterized by the presence of gaseous cystic or linear collections within the intestinal wall. Intestinal pneumatosis may be primary and idiopathic in origin or, more frequently, it accompanies various clinical conditions. Rarely, the development of intestinal pneumatosis is attributed to the pharmacotherapy with different drugs.Case report: This is a case report of cystic pneumatosis limited to the large intestine with predominant clinical presentation of chronic watery diarrhea in a 64-year-old man suffering from diabetes mellitus treated with metformin and acarbose. The patient had been referred to the outpatient gastroenterology clinic for further investigation of numerous polyp-like lesions found on colonoscopy. There was no history of cigarette smoking, drug abuse or extraintestinal complaints. The patient was in a good general condition and his laboratory tests were normal. No relevant abnormalities were found on chest X-ray, esophagogastroduodenoscopy or abdominal ultrasound, but computed tomography showed intramural gas-filled bubbles in the cecum and splenic flexure without signs of perforation or any other significant pathology in the abdominal cavity. The final diagnosis of pneumatosis cystoides coli (PCC), possibly related to treatment with acarbose, was established. On a follow-up visit after discontinuation of acarbose the patient reported no complaints and remained asymptomatic for the next 12 months.Discussion: To conclude, drug-related PCC should be considered in a differential diagnosis of gastrointestinal symptoms and/or polyp-like lesions disclosed on colonoscopy in diabetic patients treated with acarbose.

Idiopathic pneumatosis cystoides coli: An uncommon cause of pneumoperitoneum

“…PCI may involve only a segment or be diffuse. Colonoscopy may show grape-like or beaded subepithelial gas cysts [2 , 6 , 15 , 16] .…”

“…If symptoms are pronounced, the treatment may include antibiotics, oxygen, bowel rest, gastrointestinal decompression, probiotics, and supportive care. If peritoneal irritation or bowel obstruction is suspected surgery must be considered [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [19] , [20] , [21] .…”

“…Pneumatosis cystoides intestinalis (PCI) is a rare entity, characterized by the presence of gaseous cystic within the intestinal wall [1 , 2] .…”

“…Involvement of the colon is called pneumatosis cystoides coli. PCI usually has a benign course and is a chronic or self-limited process [1] , [2] , [3] , [4] .…”

Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus

“…PI is diagnosed via imaging techniques that include X-ray, computed tomography (CT), and endoscopy [ 4 ]. CT is the most sensitive medium for diagnosing PI.…”