A CASE OF PMEUMATOSIS CYSTOIDES INTESTINALIS ARISING FROM THE SIGMA ELONGATUM

A 67-year-old woman suffering from constipation by nature was referred to the hospital in September 1998 because of repeated left lower abdominal pain, abdominal distention, and stools with slime and bloodstreaking for about 4 months. When she was first seen, abdominal simple x-ray film revealed a picture like a bunch of grapes. Barium enema study revealed a great number of oval-shaped, elevated and pneumatic lesions in the sigma elongation. A diagnoisis of pneumatosis cystoides intestinalis was made. On the other hand, a colonoscopic fiber revealed a narrowing in a part of the sigmoid colon. We thought that the narrowing irreversibly changed and performed a laparotomy-aided sigmoidectomy. Pneumatosis cystoides intestinalis is a relatively rare entity that forms multiple peumatic cysts in the intestines. especially submucous or subserosal layer. There have been 509 cases of the disease in the Japanese literature as far as we could review, but mechanisms of the origin are still obscure. It is believed that hyper concentration oxygen therapy is most effective for the disease, but surgical therapy would be necessary for cases with some irreversible changes including narrowing of the intestine like this case.