An autopsy case of fulminant sepsis due to pneumatosis cystoides intestinalis

Abstract A 67-year-old female with uncontrolled diabetes mellitus (DM) was admitted to a hospital because of sudden onset of mid-abdominal pain. Laboratory data only showed mild elevation of white blood cell counts. She was diagnosed as constipation, and given laxative and enema. However, 9h after the admission, her blood pressure suddenly went down with developing of metabolic acidosis, and died 20h after the admission. Forensic autopsy revealed massive pneumohemia in the venous system. Edematous dark-brown colored lesions of mucosal surface were discontinuously observed from terminal ileum to sigmoid colon with bloody ascites. Histopathological findings showed gas cysts and lymphoid cell infiltration within colonic submucosa compatible with pneumatosis cystoides intestinalis (PCI). Anaerobes were positive in blood culture. From the clinical and histological findings, we hypothesized that PCI initially occurred, and intestinal bacterias invaded into vessels through broken mucosal barrier and developed fulminant sepsis. In recent years, anaerobic bacteremia has reemerged as a significant clinical problem due to the increasing number of patients with complex underlying disease such as malignancy, liver cirrhosis, DM and so on. In forensic autopsy anaerobic infection should be considered particularly in immuno-compromised hosts and total judgment from findings would be essential.