Abstract
The patient was a 75-year-old man who had been suffered from constipation and had been administered α-glucosidase inhibitor for diabetes since the age of 65. At the age of 74, he was found having right lung cancer, rectal carcinoid, and cerebral infarction ; and the right lung cancer was treated by irradiation and the clinical course of the rectal carcinoid was under observation. When he visited another hospital for a periodic exploration after treatment of right lung cancer, abdominal distention was pointed out and an abdominal CT scan disclosed intraabdominal free air. Thus he was referred to the hospital with a diagnosis of gastrointestinal perforation. No recognizable findings on hematological and physical examinations were revealed. Abdominal CT scans showed intraabdominal free air and intestinal mural air in the small intestine and ascending colon, but no apparent findings suggestive of gastrointestinal perforation were seen. Intestinal emphysema with pneumoperitoneum was thus diagnosed. It was etiologically considered to be caused by an increase in internal pressure of the intestine in which α-glucosidase inhibitor might participate. Conservative therapy including withdrawal of the drug provided symptomatic remission.
Intestinal emphysema associated with pneumoperitoneum in which α-glucosidase inhibitor might participate is so rare that only five cases including ours have been reported in Japan.
