Pneumatosis cystoides intestinalis induced by the alpha-glucosidase inhibitor complicated from sigmoid volvulus in a diabetic patient.

Abstract

INTRODUCTION:

We present the case of a diabetic patient on treatment with acarbose who had presented a sigmoid volvulus with localized cystic pneumatosis of the sigmoid colon.

CASE REPORT:

A 72-year-old patient with a medical history of atrial fibrillation, DNID in treatment since 10 years by acarbose. The patient was admitted to the emergency for abdominal pain and occlusive syndrome since 48 h without fever or nausea or vomiting. A CT scan was performed that showed a dolichocolon with a sigmoid volvulus. The colonic wall was thickening as well as submucosal and subserosal gas, without extra digestive air or collections. A rectosigmoidoscopy was achieving that showed a sigmoid volvulus with multiple small projections like a submucosa gas bubbles. A laparoscopic non-oncologic sigmoidectomy with primary termino terminal colorectal anastomosis was performed. During the surgical procedure, an aspect of PCI of the sigmoid colon was found. The sigmoid colon was long like a dolichocolon, dilated, and partially twisted.

DISCUSSION:

PCI is a rare condition characterized by the presence of multiple pneumokystes at different layers of the colonic wall. In emergency setting, the presence of colonic pneumatosis precludes the differential diagnosis between the PCI and mesenteric ischemia or ischemic colitis. It can be the cause of unnecessary explorative laparotomy.

CONCLUSION:

PCI is rare disease, in emergency setting, we had to consider in differential diagnosis with colonic vascular disorders.

• Authors: Andrea Police, Lionel Charre, Enrico Volpin, Christos Antonopulos, Hamdi Braham, Najib El Arbi
• Journal: International journal of colorectal disease (Int J Colorectal Dis) Vol. 35 Issue 5 Pg. 943-946 (May 2020) ISSN: 1432-1262 [Electronic] Germany
• PMID: 32095873 (Publication Type: Case Reports, Journal Article)

Chemical References

• Glycoside Hydrolase Inhibitors

Topics

• Aged
• Diabetes Mellitus (pathology)
• Endoscopy
• Glycoside Hydrolase Inhibitors (adverse effects)
• Humans
• Intestinal Volvulus (complications, diagnostic imaging)
• Pneumatosis Cystoides Intestinalis (chemically induced, complications, diagnostic imaging)
• Tomography, X-Ray Computed