A Case of Pyloric Stenosis Due to a Duodenal Ulcer, Complicated by Pneumatosis Cystoides Intestinalis with Pneumoperitoneum

Abstract

The patient was a 53-year-old man who had been followed for 2 years because of a duodenal ulcer. He was admitted to our hospital with intractable vomiting. Gastroscopy revealed severe pyloric stenosis due to a duodenal ulcer. Simple X-ray and computed tomography (CT) showed free air in the abdomen and pneumatosis cystoides intestinalis (PCI) on the small intestine. PCI is a rare disease, forming multiple gas-filled cysts on the peritoneal wall, mostly intestinal. Etiologically, increased gastrointestinal internal pressure in the case of ileus or pyloric stenosis is considered to cause pneumatosis cystoids. In our case, the pyloric stenosis was complicated by PCI, and a gastrojejunostomy was performed. Follow-up CT at one month showed no apparent findings of PCI. PCI with pneumoperitoneum is so rare that only 43 cases, including ours, have been reported in Japan.