A CASE OF PNEUMATOSIS CYSTOIDES INTESTINALIS OF THE COLON OBSERVED DURING OPERATION FOR A REMNANT GASTRIC CANCER

Pneumatosis cystoides intestinalis is a relatively rare entity. It is believed that the disease remark-ably responds to oxygen therapy, but there has been no report that the change of the lesion is directly observed during an operation under general anesthesia. We were able to observe interesting changes in size of pneumatosis cystoides intestinalis of the colon during an operation for a coexisting cancer of the remnant stomach. A 72-year-old man was seen at another hospital because of abdominal fullness and constipation, and was referred to the hospital with suspected tumor of the sigmoid colon. Barium enema and colonoscopy revealed multiple elevated lesions in the sigmoid colon. Multiple smooth elevated lesions covered with almost normal mucosa were flowed out air by puncture, and the lesion became flat. Endoscopic ultrasono-graphy showed acoustic reflection, suggesting air in the intestinal wall. Pneumatosis cystoides intestinalis of the sigmoid colon was suspected and hyperbaric oxygen therapy was done. Screening UGI endoscopy revealed a Borrmann type 1 cancer of the remnant stomach, and total excision of the remnant stomach was performed. There were two segments of pneumatosis cystoides intestinalis in the sigmoid and transverese colon, and each lesion reduced the size during the operation. Postoperative days, he was administered oxygen 21/min by a nasal catheter, and the cystic areas of pneumatosis completely disapeared in one month after the operation.