A Case of Pneumatosis Cystoides Intestinalis with Rectal Prolapse

Abstract

Pneumatosis cystoides intestinalis (PCI) is a disease that causes multiple air-containing cysts in the mucosa and submucosa of the intestine. Although abdominal free air and portal emphysema may be present, there are cases with no specific abnormalities : they lack abdominal symptoms and have no abnormal laboratory findings. In this case, a woman came to the hospital with the chief complaint of rectal prolapse. She had no obvious abdominal symptoms, but the chest X-ray incidentally showed abdominal free air under the diaphragm. Computed tomography of the abdomen showed abdominal free air (intestinal emphysema). However, she had no abdominal symptoms, and there was no inflammatory reaction on blood tests, so she was treated conservatively. The patient then underwent elective laparoscopic rectal fixation for rectal prolapse. Intraoperatively, multiple cysts were found on the mesenteric side of the ileum ; they were partially resected and histologically diagnosed as PCI. In this case, intestinal gas leaked into the intestinal wall and the abdominal cavity due to increased intestinal pressure caused by rectal prolapse. The intra-abdominal free gas improved after rectal prolapse surgery, supporting the hypothesis that the obstruction was caused by rectal prolapse. There are no reports of PCI associated with rectal prolapse, and this case is therefore reported and discussed.