Abstract
A 17-year-old man, who had been followed up for recurrent intussusception led by pneumatosis cystoides intestinalis (PCI), was seen in our hospital because of abdominal pain and anorexia. An abdominal CT scan revealed a target sign at the hepatic flexure of colon. Recurrence of PCI-induced intussusception was diagnosed. Colonoscopy successfully reduced it and showed multiple elevated lesions extending from the cecum to the mid transverse colon. An elective laparoscopic right hemicolectomy was performed because repeated relapse was expected even after this reduction. The resected specimen involved multiple submucosal emphysematous bullas, which had multilocular cyst-like structure from the cecum to the mid transverse colon. Histopathological examination revealed pneumatosis without lining of epithelium in the submucosal layer. There were clusters of foreign-body giant cells and epithelioid histiocytes inside the pneumatosis.
PCI is an uncommon disease, characterized by the presence of air-filled cysts within the submucosa and/or subserosa of the intestinal wall. It is difficult to achieve complete remission of intussusception led by pneumatosis by conservative treatments such as hyperbaric oxygen therapy because PCI has an unknown etiology. PCI can lead to relapse of intussusception unless pneumatosis is resolved. Therefore, idiopathic PCI causing intussusception could be indication for elective surgery.
