Abstract
A 60-year-old woman was seen at the department of medicine in our hospital because of abdominal pain and abdominal distention. There were previous histories of appendicitis required surgery, Hashimoto disease, and twice admissions for intestinal obstruction. Chest and abdominal plain x-ray films and CT scan showed intra-abdominal free air. Accordingly she was referred to our surgical department, but there was no peritoneal sign and her general condition was stable, without showing inflammatory reaction on a blood analysis. Since CT scan revealed findings of pneumatosis cystoides intestinalis (PCI), free air associated with PCI was likely. Conservative therapy resulted in rapid symptomatic remission. Following close exploration done thereafter, chronic intestinal pseudo-obstruction was diagnosed. Further several months later, she visited a department of general internal medicine in a core hospital because of general edema and was diagnosed as having scleroderma.
There have been 27 reported cases of PCI associated with scleroderma in Japan. As PCI can be associated with intra-abdominal free air, we have to determine whether laparotomy is required or not in some cases. In many cases of them, perforation and mechanical obstructive mechanism are not accompanied by, so that we should carefully determine by considering clinical findings as well as previous histories including scleroderma.
