Pneumatosis Cystoides Intestinalis Associated with Free Air in the Abdomen during Palliative Care for Bone Metastases of Breast Cancer

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 47; no. 11; pp. 726 - 733
• Main Authors: Konishi, Hiroo, Okamura, Hiroko, Kawai, Kanzi, Sagara, Yukihiko
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.11.2014
• Subjects: intraabdominal free air; palliative therapy; pneumatosis cystoides intestinalis
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2014.0017

The patient was a 74-year-old woman who developed thoracolumbar vertebral metastases after surgery for bilateral breast cancer and underwent palliative therapy by oral administration of oxycodone. She urgently came to our hospital due to increased back pain and malaise. Abdominal CT showed the presence of free air in the abdominal cavity and an emphysematous lesion. Peritoneal irritation signs were not apparently detected by the initial physical examination. However, the lack of symptoms was thought to be caused by oxycodone. As the possibility of gastrointestinal perforation could not be denied, exploratory laparotomy was performed. Surgery revealed an emphysematous lesion about 10 cm in length at the ileum site of the mesentery but no perforation. Assuming the possibility of metastasis of breast cancer to the small intestine, partial ileal resection was performed. Postoperative histopathology indicated pneumatosis cystoides intestinalis. Recently, pneumatosis cystoides intestinalis has been increasingly reported and there is a certain level of consensus on the diagnosis and treatment. Herein, we report the present case, demonstrating the difficulty in the diagnosis and treatment of pneumatosis cystoides intestinalis associated with free air in the abdomen during palliative therapy, with a review of the literature.