Abstract
In August 2012 an 81-year-old man with a history of dementia, hypertension, sequelae of cerebral infarction, and a right foot amputation secondary to arteriosclerosis obliterans was admitted for unremitting hematochezia and vomiting. His whole abdomen was tender, but there was no evidence of peritonitis. Abdominal contrast-enhanced computed tomography (CT) showed evidence of pneumatosis at the small intestinal wall, free intraperitoneal air, and portal vein gas (PVG). Under a diagnosis of pneumatosis cystoides intestinalis (PCI) conservative therapy was initiated because the abdominal tenderness was mild, the amount of PVG was small, and the pneumatosis was located within the small intestine. Furthermore, obtaining informed consent from his family for other therapy was difficult. Fourteen days after conservative therapy was started, enhanced CT showed that the free intraperitoneal air, the PVG, and the pneumatosis had disappeared. In some cases of PCI with symptoms of intestinal necrosis or perforation such as intraperitoneal free air or PVG, emergency surgery might be required. However, our case suggests that surgical intervention can be more circumspect in patients with PCI localized within the small intestine.
