An Autopsy Case of Recurrent Pneumatosis Cystoides Intestinalis with Multiple Organ Infarction

Abstract

An 88-year-old woman complaining of lower abdominal pain was suspected to have bowel necrosis with intestinal emphysema by an abdominal CT scan, and underwent laparotomy. At surgery, an ischemic change was demonstrated at a part of the ileum, and resection of the small intestine was performed. Histopathology revealed necrosis extending through the full thickness of the bowel wall and intramural emphysema in the vicinity of the necrotized intestine. After discharge, the patient was seen again because of abdominal pain. An abdominal CT scan showed air in the mesentery, and reoperation was performed. Air bubbles were identified in the mesentery of the ileum and the area was resected with a suspicion of bowel perforation. Grossly no perforation was seen. Histopathology showed multiple gas cysts within the bowel wall. Pneumatosis cystoides intestinalis was thus diagnosed. The patient developed intractable diarrhea after the operation. Small-bowel endoscopy revealed a hemispheric elevated lesion in the jejunum. Her abdominal pain became worse on the 67^th hospital day when an abdominal CT scan showed extensive intramural emphysema from the stomach to the transverse colon, portal gas, and areas in the liver where circulation was not well. She died of multiple organ infarction. An autopsy gave the same findings. As clinical cases of pneumatosis cystoides intestinalis with multiple organ infarction have rarely been reported, we present this case together with a review of the literature.