Abstract
We present a case of a 67-year-old woman with diabetes mellitus who was being treated for poor glycemic control with miglitol, an α-glucosidase inhibitor (αGI) drug. Approximately 8 months after starting the medication, she was admitted to our hospital with acute abdominal pain and fever. Laboratory data showed increased C-reactive protein (CRP) levels. Imaging findings showed massive intraperitoneal free air, foamy gas collections throughout the small bowel wall and the mesentery, and thinning of a segment of the small bowel wall. A presumptive diagnosis of pneumatosis cystoides intestinalis (PCI) with perforation of the small bowel was made, and an exploratory laparotomy was performed. However, intraoperative findings revealed no perforation in the gastrointestinal tract and foamy gas collections were located only in the ileum, throughout the ileal wall and the adjacent mesentery. Miglitol medication was stopped postoperatively and no further evidence of PCI has been noted on follow-up exam 1 year after surgery. This is the first report of PCI arising as a complication of miglitol therapy. Many PCI lesions due to miglitol appear in the large bowel. However, in this case, PCI lesions were present only in the ileum. Since miglitol suppresses absorption of glucose in the proximal small bowel unlike other αGI drugs, we suggest that the etiology of PCI in this scenario is due to increased ileal intraluminal pressure resulting from the maximal glucose absorption and fermentation taking place in the distal small bowel with minimal involvement of the large bowel.
