Pneumatosis Cystoides Intestinalis

An 80-year-old man presented to our hospital with 2 weeks of worsening vomiting and anorexia. He had no abdominal pain and only had slight abdominal distention on physical examination. Abdominal radiography showed dilatation of the small intestine and retention of gas in the 1 long segment of the small intestinal wall (Figure A). Contrast-enhanced computed tomography of the abdomen showed massive gas-filled cysts within the wall and mesentery of the small intestine (Figure B). Intraperitoneal free air and moderate ascites were present (Figure C), and retroperitoneal emphysema also was present. No features suggested portal venous gas or intestinal ischemia. Colon wall thickening, seen as a homogeneous enhancement extending from the ascending to the descending colon, also was identified. We diagnosed pneumatosis cystoides intestinalis and instituted conservative management such as fasting treatment and antibiotic therapy. Hyperbaric oxygen treatment was not administered. After confirmation of the disappearance of the previous imaging findings (Figure D), we investigated the etiology using endoscopy to the extent possible. However, we found no significant findings. Fecal culture yielded normal flora and no anaerobes such as Clostridium perfringens. The exact etiology was unclear, but pneumatosis cystoides intestinalis associated with enterocolitis was suspected from the presenting symptoms and computed tomography findings.