2015 Volume 35 Issue 1 Pages 141-145
The patient was an 86-year-old woman who was under treatment with an α-glucosidase inhibitor for diabetes. She was transferred to another hospital because of decreased level of consciousness. Because abdominal CT revealed intra-abdominal free air, she was admitted to our hospital, where she was clinically diagnosed as having hyperosmolar nonketotic acidosis and perforation of the gastrointestinal tract. Therefore, exploratory surgery was performed；the laparotomy revealed intramural emphysema in the small intestine, but no perforation of the gastrointestinal tract. Based on the operative findings, pneumatosis cystoides intestinalis associated with intra-abdominal free air was diagnosed. We suspected that the α-glucosidase inhibitor may have contributed to the development of the pneumatosis cystoides intestinalis, and discontinued the medicine. The patient was discharged on the 31st postoperative day. Pneumatosis cystoides intestinalis associated with intra-abdominal free air that may be causatively related to the use of an α-glucosidase inhibitor is comparatively rare, and so far only 15 cases, including our case, have been reported in Japan. In addition, such a patient presenting with impaired consciousness has never been reported.
