Zhou Wenjie, Dan Jie, Zhu Mingjie, Liu Ke, Wang Yonghong
Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Leshan, Sichuan Province, China.
Medicine (Baltimore). 2025 Jul 18;104(29):e43481. doi: 10.1097/MD.0000000000043481.
Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by gas accumulation in the intestinal wall, and is usually treated conservatively. Patients with diabetic ketoacidosis (DKA) sometimes present with severe abdominal pain as the first symptom, which may be misdiagnosed. We report a case of PCI in a patient with diabetes mellitus (DM) misdiagnosed as gastrointestinal perforation and underwent exploratory laparotomy.
A 41-year-old woman with a history of DM treated with miglitol, an α-glucosidase inhibitors (αGI), was admitted to the emergency department with severe abdominal pain. Computed tomography revealed thickening of the ascending colon wall and scattered free gas around it, and the possibility of tumor perforation was considered.
The patient was diagnosed with gastrointestinal perforation and DM but was revised to PCI and DKA after surgery.
The patient underwent exploratory laparotomy; however, no signs of digestive perforation were found. The patient developed DKA after surgery and received conservative treatment, including antibiotics, insulin, fluid support, oxygen therapy, and cessation of miglitol.
Ketoacidosis was controlled, and the abdominal pain resolved with conservative treatment. She was discharged 16 days later and no longer required αGI therapy. She did not develop gastrointestinal symptoms or any signs of PCI on computed tomography imaging within 3 months.
PCI is a rare disease with great heterogeneity in etiology, treatment and prognosis and comorbidities like diabetes may increase the chances of misdiagnosis. Surgeons should pay attention to the patient's medical history and examination and carefully identify the real disease that triggers the symptoms to avoid misdiagnosis.
肠壁囊样积气症（PCI）是一种罕见疾病，其特征为肠壁内气体积聚，通常采用保守治疗。糖尿病酮症酸中毒（DKA）患者有时以严重腹痛为首发症状，可能会被误诊。我们报告一例糖尿病（DM）患者被误诊为胃肠道穿孔并接受了剖腹探查术的PCI病例。
一名41岁有DM病史且正在接受α-葡萄糖苷酶抑制剂米格列醇治疗的女性因严重腹痛入住急诊科。计算机断层扫描显示升结肠壁增厚且其周围有散在游离气体，考虑有肿瘤穿孔的可能。
患者最初被诊断为胃肠道穿孔和DM，但术后修正诊断为PCI和DKA。
患者接受了剖腹探查术；然而，未发现消化穿孔迹象。患者术后发生DKA并接受了保守治疗，包括使用抗生素、胰岛素、液体支持、氧疗以及停用米格列醇。
酮症酸中毒得到控制，保守治疗后腹痛缓解。她于16天后出院，不再需要α-葡萄糖苷酶抑制剂治疗。在3个月内计算机断层扫描成像未见胃肠道症状或PCI的任何迹象。
PCI是一种罕见疾病，在病因、治疗、预后方面具有很大异质性，像糖尿病这样的合并症可能增加误诊几率。外科医生应注意患者病史和检查情况，仔细识别引发症状的真正疾病以避免误诊。
