Six Cases of Pneumatosis Cystoides Intestinalis (PCI) That Improved with Conservative Treatment

Abstract

This report describes the cases of six patients aged 66 to 88 years old who complained of abdominal pain or vomiting. CT examination revealed pneumatosis intestinalis in all patients, of whom three patients had intra-abdominal free air and one had portal venous gas. These conditions required differential diagnosis from gastrointestinal perforation or bowel necrosis. The scans also showed ascites in three patients. Comorbidities were chronic obstructive pulmonary disease in two patients, risperidone usage in three, an alpha-glucosidase inhibitor usage in one, steroid usage in one, and constipation in three. Thus, all patients had a medical history and/or were taking drugs which seemed to be the causative factor for PCI. We avoided surgical treatment based on physical findings and test results and the patients were treated conservatively, including discontinuation of causative drugs. The main reason why exploratory laparotomy was avoided was to understand the causative mechanism and the pathology of PCI. This report describes these six cases of PCI treated conservatively and also discusses the pathogenesis and surgical indications based on the literature.