2024 Volume 57 Issue 8 Pages 367-373
An 82-year-old man had a history of having undergone a Miles procedure, which was complicated by repeated episodes of adhesive small intestinal obstruction approximately once a year. He was hospitalized for deterioration of his Parkinson’s disease. He experienced vomiting, and CT was performed. He was found to have extensive submucosal emphysema extending from the dilated ileum to the esophagus, as well as portal venous gas. Our department was consulted to determine whether surgical treatment was necessary. There was a stricture in the ileum, and the submucosal emphysema was thought to be due to increased intestinal pressure. His vital signs and an abdominal examination were unremarkable, and contrast-enhanced CT showed no poorly contrasted intestinal tract or intraperitoneal free air; therefore, conservative treatment was deemed appropriate. His symptoms improved, and the emphysema resolved. If the cause of pneumatosis intestinalis is intestinal necrosis, emergency surgery is required; however, in some cases, such as those with drug-induced or idiopathic causes, the condition can be managed conservatively. Here, we report the case of a patient with widespread emphysema that was relieved with conservative treatment.
