Abstract
A 65-year-old man with a long-term history of diabetes mellitus and intake of α-glucosidase inhibitor (α-GI) visited our hospital because of a 3-day history of abdominal distention with sudden worsening with severe pain. An abdominal enhanced computed tomography scan showed massive emphysema in the submucosa from the ascending to transverse colon. He had tenderness in the right upper quadrant, elevation of inflammation reaction, and sepsis ; hence, we proceeded with emergent laparotomy for a possibility of colon necrosis. Massive trapped air was present in the subserosa of the ascending and transverse colon, but the color of the colon was normal. Colon necrosis was unlikely and only drainage procedure was performed. We believed that his sepsis was caused by bacterial translocation along with pneumatosis intestinalis, and antibiotic therapy was started. After the inflammation reaction levels fell to near the normal range, he was discharged on the 19th postoperative day. It is known that α-GI has an adverse effect of increasing intestinal gas, and some cases of pneumatosis intestinalis during α-GI regimen have been reported. Early diagnosis and appropriate treatments are needed.
