A case of pneumatosis cystoides intestinalis with pneumoperitoneum induced by α-glucosidase inhibitor

Abstract

A node was pointed out in the left lung of a 79-year-old woman, and she was followed at our hospital. She started to take α-glucosidase inhibitor (α-GI) one month ago for diabetes mellitus. A follow-up CT scan performed for pulmonary check showed growth of the pulmonary node and a reticular shadow in the whole left lung. The lesion was diagnosed as lung cancer. Additionally, it revealed intra-abdominal free air and intestinal mural air in the right colon. However, there were no apparent findings to suggest gastrointestinal perforation. Therefore, we diagnosed pneumatosis cystoides intestinalis (PCI) with pneumoperitoneum induced by α-GI. The patient's condition was improved by conservative therapy including withdrawal of α-GI. PCI with pneumoperitoneum induced by α-GI is very rare, and only five cases including ours have been reported in Japan. These three of five cases had a history of respiratory diseases, and we suggest that respiratory disease was also involved in the occurrence of PCI with pneumoperitoneum.