A Case of Lower Gastrointestinal Perforation due to Intussusception Triggered by Pneumatosis Cystoides Intestinalis

Abstract

A 48-year-old man was referred to our hospital because of lower abdominal pain and bloody stools since the day before his arrival. Abdominal computed tomography showed a target sign in the splenic flexure and numerous aerobic cysts on the oral side of the colon, which led to the diagnosis of intussusception by pneumatosis cystoides intestinalis (PCI). Based on the poor contrast of the intestinal wall and the intra-abdominal free gas, the possibility of gastrointestinal perforation was considered, and emergency surgery was performed. Surgical findings showed that the transverse colon had aerobic cysts and intussusception in the splenic flexure. Since manual repair of the intussusception was difficult, a partial colonic resection was performed to avoid residual aerobic cysts. Because the resected colon showed microperforation, and the histopathological findings were consistent with PCI, gastrointestinal perforation due to intussusception associated with PCI was diagnosed. Intussusception by PCI often occurs in the right side of the colon, but in this rare case, gastrointestinal perforation due to intussusception by PCI occurred in the left side of the colon. This case is reported along with a review of the relevant literature.