IMAGES IN CLINICAL MEDICINE

Pneumatosis Cystoides Intestinalis

Yuusaku Sugihara, M.D., Ph.D., and Hiroyuki Okada, M.D., Ph.D.

N Engl J Med 2017; 377:2266

DOI: 10.1056/NEJMicm1701357

A 48-year-old woman presented to an outpatient clinic with a several-month history of abdominal fullness. She also had a history of eosinophilic pneumonia, which had been treated continuously with glucocorticoids for 7 years. On examination, her abdomen was distended but soft, with normal bowel sounds. Computed tomography (CT) of the abdomen showed air in multiple small cysts within the wall of the colon (arrows) and free air under the right hemidiaphragm (arrowhead), findings consistent with a diagnosis of pneumatosis cystoides intestinalis. This condition is characterized by the presence of numerous gas-containing cysts within the submucosal or subserosal layer of the intestinal wall. The pathophysiology is incompletely understood. Pneumatosis cystoides intestinalis may be associated with a range of gastrointestinal conditions, from intestinal ischemia to inflammatory bowel disease, as well as with endoscopic procedures, mechanical ventilation, and pulmonary diseases. Management of the condition is guided by the severity of the clinical presentation, which can vary on the basis of the underlying cause. The patient was admitted to the hospital, where she received supportive care, including oxygen administered through a face mask. Over the next 3 days, her abdominal symptoms decreased, and a repeat CT showed resolution of both the free air and the air in the intestinal wall.

一名48岁女性患者因腹部胀满感数月到门诊就诊。患者既往有嗜酸性粒细胞肺炎病史，使用糖皮质激素治疗已有7年。体格检查发现，患者腹胀但软，肠鸣音正常。腹部CT显示结肠肠壁内多发小囊伴囊内积气（箭头），且右侧膈肌下方有游离气体（箭镞），这些表现符合肠壁囊样积气的诊断。肠壁囊样积气的临床特点为肠壁粘膜下层或浆膜下层多发含气囊，其病理生理尚未完全清楚。多种胃肠道疾病可发生肠壁囊样积气，从肠道缺血炎性肠病，以及内镜下操作，机械通气和肺部疾病等。肠壁囊样积气的治疗依据临床表现的严重程度，后者可因基础疾病不同有所不同。患者入院接受支持治疗，包括经面罩氧疗。经过3天治疗，患者腹部症状减轻，复查CT发现腹腔游离气体及肠壁内气体消失。