Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 21, 2008; 14(39): 6087-6092
Published online Oct 21, 2008. doi: 10.3748/wjg.14.6087
Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: A case report and review of the literature
Tatsuhiro Tsujimoto, Erika Shioyama, Kei Moriya, Hideto Kawaratani, Yasuyo Shirai, Masahisa Toyohara, Akira Mitoro, Jun-ichi Yamao, Hisao Fujii, Hiroshi Fukui
Tatsuhiro Tsujimoto, Erika Shioyama, Kei Moriya, Hideto Kawaratani, Yasuyo Shirai, Masahisa Toyohara, Akira Mitoro, Jun-ichi Yamao, Hiroshi Fukui, Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 634-8522, Japan
Hisao Fujii, Department of Endoscopy and Ultrasound, Nara Medical University, Kashihara, Nara 634-8522, Japan
Author contributions: Tsujimoto T and Shioyama E designed the work; Tsujimoto T wrote the article; Shioyama E, Moriya K, Kawaratani H, Shirai Y, Toyohara M, Mitoro A and Yamao J followed up the patient; Fujii H and Fukui H reviewed the article.
Correspondence to: Tatsuhiro Tsujimoto, MD, PhD, Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. tat-tyan@xa2.so-net.ne.jp
Telephone: +81-744-223051 Fax: +81-744-247122
Received: July 28, 2008
Revised: September 24, 2008
Accepted: October 1, 2008
Published online: October 21, 2008
Abstract

A 69-year-old man was diagnosed as having myasthenia gravis (MG) in September 2004, and treated with thymectomy and prednisolone. He was then diagnosed as having steroid-induced diabetes mellitus, and received sulfonylurea (SU) therapy in May 2005. An alpha- glucosidase inhibitor (αGI) was added in March 2006, resulting in good glycemic control. He experienced symptoms of abdominal distention, increased flatus, and constipation in October 2007, and was admitted into our hospital in late November with hematochezia. Plain abdominal radiography revealed small linear radiolucent clusters in the wall of the colon. Computed tomography (CT) showed intramural air in the sigmoid colon. Colonoscopy revealed multiple smooth surfaced hemispherical protrusions in the sigmoid colon. The diagnosis of pneumatosis cystoides intestinalis (PCI) was made on the basis of these findings. As the αGI voglibose was suspected as the cause of this patient’s PCI, treatment was conservative, ceasing voglibose, with fasting and fluid supplementation. The patient progressed well, and was discharged 2 wk later. Recently, several reports of PCI associated with αGI therapy have been published, predominantly in Japan where αGIs are commonly used. If the use of αGIs becomes more widespread, we can expect more reports of this condition on a global scale. The possibility of PCI should be considered in diabetic patients complaining of gastrointestinal symptoms, and the gastrointestinal tract should be thoroughly investigated in these patients.

Keywords: Alpha-glucosidase inhibitor; Colonoscopy; Diabetes mellitus; Pneumatosis cystoides intestinalis; Voglibose