CA S E R E P O R T Open Access
Prolonged postoperative ileus in a patient
with primary pneumatosis cystoides
intestinalis: a case report
Hiroshi Tamura
1,2
, Tatsuo Kanda
1*
, Tadasu Chida
1
, Hitoshi Kameyama
2
, Ukihide Tateishi
3
, Toshifumi Wakai
2
and Makoto Naito
4
Abstract
Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gas-filled cysts in the
intestinal wall and is associated with various comorbidities. We report herein a case of intractable paralytic ileus caused by
primary PCI.
Case presentation: A 73-year-old man visited out hospital complaining of abdominal pain and vomiting. He had been
hospitalized twice for intestinal obstruction in the past 2 months. Based on his history of appendectomy, mechanical
bowel obstruction caused by adhesion was diagnosed, and the patient underwent surgery. However, laparotomy revealed
small bowel dilatation despite the absence of obstruction or stenosis. Multiple nodules were found in the wall of the
dilated bowel loops. The dilated jejunum was excised. Histological examination revealed that the nodules were small
gas-filled cysts, suggesting PCI. We made a diagnosis of ileus with underlying PCI and managed the patient
conservatively. A large amount of nasogastric tube drainage continued for a long period postoperatively. The patient
underwent relaparotomy 35 days after the first operation. The upper jejunum was markedly dilated, although no
mechanical stenosis was found. The atonic, dilated jejunum was excised and the ileal stump was anastomosed to the
duodenum in a double tract fashion. The patient underwent hyperbaric oxygen therapy because the ileus persisted
postoperatively. His condition gradually improved and he was discharged 53 days after the second operation.
Conclusions: Non-operative treatment is recommended for primary PCI of unknown etiology. Surgeons should be
mindful of the possibility of primary PCI when considering surgical intervention for patients with bowel obstruction.
Keywords: Paralytic ileus, Pneumatosis cystoides intestinalis, Hyperbaric oxygen therapy, Duodenum
Background
Pneumatosis cystoides intestinalis (PCI) is a rare disease
characterized by the presence of multilocular gas-filled cysts
in the intestinal wall. The etiology of PCI is still unclear,
although many theories have been proposed. Secondary
PCI, which is associated with bowel obstruction or necrosis,
is an indication for urgent surgery, while surgical interven-
tion is usually unnecessary for primary or idiopathic PCI.
Despiteaconsiderablenumberofcasereports,primaryPCI
is still not widely recognized as a disease entity. We report
here a case of primary PCI where the patient underwent
surgery and had prolonged postoperative ileus.
Case presentation
A 73-year-old man with a history of appendectomy
50 years earlier visited our hospital complaining of ab-
dominal pain and vomiting. The patient had been hospi-
talized twice in the past 2 months because of bowel
obstruction. Abdominal X-ray showed dilated small-bowel
loops with air-fluid levels. Computed tomography (CT)
scans revealed dilation of the upper small bowel and the
presence of intramural gas in a part of the dilated bowel
segments. No causative lesion was identified (Fig. 1). We
diagnosed small-bowel obstruction associated with intes-
tinal pneumatosis secondary to increased intraluminal
* Correspondence: kandat@herb.ocn.ne.jp
1
Department of Surgery, Sanjo General Hospital, Tsukanome, Sanjo 955-0055,
Japan
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Tamura et al. Surgical Case Reports (2018) 4:22
https://doi.org/10.1186/s40792-018-0431-6
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