A Case of Pneumatosis Cystoides Intestinalis and Portal Venous Gas Accompanied by Emphysematous Pyelonephritis in Type 2 Diabetes Mellitus

Seung Hee Yu; Young Sil Eom; Dong Min Lee; Sihoon Lee; Yeun Sun Kim; KI Young Lee; Joon Kim Byung; Kwang Won Kim; Ie Byung Park

doi:10.4093/jkd.2014.15.1.45

Journal List > J Korean Diabetes > v.15(1) > 1054947

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yu, Eom, Lee, Lee, Kim, Lee, Byung, Kim, and Park: A Case of Pneumatosis Cystoides Intestinalis and Portal Venous Gas Accompanied by Emphysematous Pyelonephritis in Type 2 Diabetes Mellitus

Original Articles & Case Reports

J Korean Diabetes 2014;15(1):45-50.

Published online: 10 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.1.45

A Case of Pneumatosis Cystoides Intestinalis and Portal Venous Gas Accompanied by Emphysematous Pyelonephritis in Type 2 Diabetes Mellitus

Seung Hee Yu, Young Sil Eom, Dong Min Lee, Sihoon Lee, Yeun Sun Kim, KI Young Lee, Joon Kim Byung, Kwang Won Kim, Ie Byung Park

Department of Internal Medicine, Gachon University, College of Medicine, Incheon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetes mellitus is a major risk factor for urinary tract infection (UTI); emphysematous pyelonephritis (EP), a complication of UTIs, often occurs in patients with underlying, poorly controlled diabetes mellitus. We report the case of an 87-year-old woman with EP in type 2 diabetes mellitus who developed pneumatosis cystoides intestinalis (PCI) with portal venous gas. PCI is a radiographic finding, which is found in a linear or cystic form of gas in the submucosa or subserosa of the bowel wall. PCI has two common presentations. Primary PCI is a benign idiopathic condition. Secondary PCI is associated with a wide variety of gastrointestinal and non-gastrointestinal diseases. PCI with portal venous gas in particular is associated with ischemic gastrointestinal disease. Initial pre-enhanced abdominopelvic computed tomography showed EP in the right kidney without PCI. Newly occurring PCI and hepatic portal venous gas were found in the right ascending colon after EP improved. This is a rare case of PCI accompanied by emphysematous pyelonephritis in type 2 diabetes mellitus. The patient's general condition improved with intravenous antibiotics and fluid therapy without a surgical approach. However, she was discharged without further treatment because the family refused any further evaluations and treatments.

Keywords: Pneumatosis cystoides intestinalis, Pyelonephritis, Diabetes mellitus

References

1. Boyko EJ, Fihn SD, Scholes D, Chen CL, Normand EH, Yarbro P. Diabetes and the risk of acute urinary tract infection among postmenopausal women. Diabetes Care. 2002; 25:1778–83.

2. Mnif MF, Kamoun M, Kacem FH, Bouaziz Z, Charfi N, Mnif F, Naceur BB, Rekik N, Abid M. Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management. Indian J Endocrinol Metab. 2013; 17:442–5.

3. Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA. Pneumatosis intestinalis: a review. Am J Gastroenterol. 1995; 90:1747–58.

4. KOSS LG. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis); an analysis with a report of a case and a critical review of the literature. AMA Arch Pathol. 1952; 53:523–49.

5. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007; 188:1604–13.

6. Connor R, Jones B, Fishman EK, Siegelman SS. Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comput Assist Tomogr. 1984; 8:269–75.

7. Jamart J. Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Acta Hepatogastroenterol (Stuttg). 1979; 26:419–22.

8. Wang JH, Furlan A, Kaya D, Goshima S, Tublin M, Bae KT. Pneumatosis intestinalis versus pseudo-pneumatosis: review of CT findings and differentiation. Insights Imaging. 2011; 2:85–92.

9. Ihara E, Harada N, Motomura S, Chijiiwa Y. A new approach to Pneumatosis cystoides intestinalis by target air-enema CT. Am J Gastroenterol. 1998; 93:1163–4.

10. Wiesner W, Mortelé KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol. 2001; 177:1319–23.

11. Pieterse AS, Leong AS, Rowland R. The mucosal changes and pathogenesis of pneumatosis cystoides intestinalis. Hum Pathol. 1985; 16:683–8.

12. Kay-Butler JJ. Interstitial emphysema of the caecum. Gut. 1962; 3:267–8.

13. Pear BL. Pneumatosis intestinalis: a review. Radiology. 1998; 207:13–9.

14. Keyting WS, Mccarver RR, Kovarik JL, Daywitt AL. Pneumatosis intestinalis: a new concept. Radiology. 1961; 76:733–41.

15. Yale CE, Balish E, Wu JP. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg. 1974; 109:89–94.

16. Ellis BW. Symptomatic treatment of primary pneumatosis coli with metronidazole. Br Med J. 1980; 280:763–4.

17. Gruenberg JC, Grodsinsky C, Ponka JL. Pneumatosis intestinalis: a clinical classification. Dis Colon Rectum. 1979; 22:5–9.

18. Kojima K, Tsujimoto T, Fujii H, Morimoto T, Yoshioka S, Kato S, Yasuhara Y, Aizawa S, Sawai M, Makutani S, Yamamoto K, Mochi T, Fukui H. Pneumatosis cystoides intestinalis induced by the α-glucosidase inhibitor miglitol. Intern Med. 2010; 49:1545–8.

19. Min SY, Kim JI, Choi PW, Park JH, Heo TG, Lee MS, Kim CN, Chang SH, Kim HS. Clinical review of pneumatosis intestinalis. J Korean Surg Soc. 2010; 79:467–73.

20. Yip CK, Wong HY, Chan PS, Metreweli C. Emphysematous pyelonephritis simulating intestinal obstruction and pneumatosis intestinalis. Australas Radiol. 1990; 34:344–6.

Fig. 1.

Pre-enhanced abdominopelvic computed tomography showed intraparenchymal, intracalyceal and intrapelvic mottled air densities in the right kidney.

Fig. 2.

Pneumatosis cystoides intestinalis (PCI), portal venous gas and mesenteric venous gas were newly observed in pre-enhanced abdominopelvic computed tomography. (A) The air densities in the right kidney have nearly disappeared. (B) Portal venous gas (arrow). (C) Air density within the superior mesenteric vein and the mesenteric vessels (arrow). (D) PCI in the wall of the right ascending colon (arrow).

TOOLS

Similar articles