Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: A case report and review of the literature

Table 1 A summary of previously reported cases of pneumatosis cystoides intestinalis (PCI) after an alpha-glucosidase inhibitor (αGI) treatment

Case No.	Author	Age	Chief complaint	TheαGI agent	Disease other than diabetes mellitus	Concomitant drug	Prescription ofαGI after PCI onset	Treatment
	Reference number	Sex		Quantity ofαGI				Outcome
	Yr			Dosage period ofαGIprior to PCI onset				Duration to the outcome
1	Hayakawa et al	64	Abdominal distention	Voglibose	Unknown	Insulin	Discontinuation	Conservative treatment
	14	F		0.6 mg/day				Healing
	1999			1 mo				4 d
2	Azami	87	Abdominal distention	Acarbose	Hypothyroidism	SU	Discontinuation	Conservative treatment
	15	F	Appetite loss	150 mg/day				Healing
	2000			1 yr				5 d
3	Maeda et al	55	Abdominal distention	Acarbose	Pemphigus vulgaris	Insuline steroid Immunosupressant	Continuation	Conservative treatment
	16	F		300 mg/day				Healing
	2002			42 d				141 d
4	Tachibana et al	73	Abdominal distention	Acarbose	Henoch-Schonlein	SU Steroid	Discontinuation	Conservative treatment
	17	F		150 mg/day	purpura nephritis			Healing
	2002			8 yr				28 d
5	Yanaru et al	61	Abdominal distention	Voglibose	Unknown	SU	Discontinuation	Conservative treatment
	18	M	Constipation	0.6 mg/day				Healing
	2002		Hematochezia	5 yr				28 d
6	Matsuda et al	62	Abdominal pain	Voglibose	Lung cancer	Morphine sulfate	Unknown	Operation
	19	M		Unknown				Remission
	2004			Unknown				16 d
7	Nagahara et al	66	Left abdominal pain	Acarbose	Unknown	Unknown	Discontinuation	Conservative treatment
	20	M		Unknown				Healing
	2006			11 yr				21 d
8	Hisamoto et al	56	No abdominal symptoms	Voglibose	Interstitial pneumonia	Steroid	Discontinuation	Conservative treatment
	21	M		0.6 mg/day				Healing
	2006			7 d				7 d
9	Furio et al	64	Abdominal pain	Acarbose	Unknown	Insulin	Discontinuation	Conservative
	22	F	Diarrhea	Unknown				treatment
	2006		Tenesmus	3 yr				Healing
			Weight loss					15 d
10	Miyagawa et al	65	Abdominal pain	Voglibose	Gastric cancer	SU	Continuation→Discontinuation	Conservative treatment
	23	M	Diarrhea	0.6 mg/day				Healing
	2006			6 years				120 d
11	Yasuoka et al	75	Abdominal distention	Voglibose	Lung cancer	SU	Discontinuation	Conservative treatment
	24	M		0.6 mg/day	Rectal carcinoid			Healing
	2007			10 yr				20 d
12	Maeda et al	72	Rt lower abdominal pain	Voglibose	Minimal change disease	Insulin	Discontinuation	Conservative treatment
	25	F		0.9 mg/day		Steroid		Healing
	2007			3 yr		Immunosupressant		7 d
13	Saito et al	53	Abdominal distention	Voglibose	Dermatomyositis	Steroid	Discontinuation	Conservative treatment
	26	F	Nausea	0.6 mg/day		Immunosupressant		Healing
	2007			1 mo				21 d
14	Our case	69	Abdominal distention	Voglibose	Myasthenia gravis	SU Steroid	Discontinuation	Conservative treatment
		M	Hematochezia	0.6 mg/day				Healing
	2008			1 yr 8 mo				14 d

Table 2 Imaging findings in previously reported cases of PCI after an αGI treatment

Case	Author	Plain radiography of the abdomen	Computed tomography of the abdomen	Barium enema	Colonoscopy
No.	Reference number
	Year
1	Hayakawa et al	Distention of the ascending and proximal transverse colon with cystic radiolucencies, indicating intramural gas	Subserosal cystic areas of gas and distention of the involved segments	Translucent areas of gas clustered along the distorted contours of the ascending and transverse colon	ND
	14
	1999
2	Azami	Noticeable gaseous distension of the small intestine	Noticeable gaseous distention of the small intestine with pockets of small gas bubbles in the submucosal space	No constriction in the sigmoid or lower descending colon	ND
	15
	2000
3	Maeda et al	Multiple cystic radiolucencies in the abdomen	Pneumatosis intestinalis around the bowel wall and gas within the retroperitoneum	ND	ND
	16
	2002
4	Tachibana et al	Free gas of the right peritoneal cavity and pneumatosis intestinalis throughout the ascending colon	Free gas below the right diaphragm, and pneumatosis intestinalis throughout the ascending colon	ND	Polypoid lesions in the ascending and transverse colon
	17
	2002
5	Yanaru et al	Small round radiolucent clusters in the middle abdomen	ND	Numerous submucosal protrusions of sessile of semipedunculated configurations	Numerous submucosal protrusions of sessile of semipedunculated configurations
	18
	2002
6	Matsuda et al	Noticeable gaseous distention of the colon, and curvilinear radiolucency within the bowel wall	Free gas in the peritoneal cavity, pneumatosis intestinalis throughout the bowel wall	ND	ND
	19
	2004
7	Nagahara et al	Free air below the diaphragm	Pneumatosis intestinalis throughout the ascending colon	ND	ND
	20
	2006
8	Hisamoto et al	Free air below the diaphragm, and noticeable gaseous distention of the ascending and transverse colon	Slight dialatation, mesenteric edema, and diffuse pneumatosis intestinalis throughout the ascending colon	Many cystic areas of the ascending colon	Multiple sessile polypoid lesions covered with normal-appearing mucosa in the area from the ascending colon
	21
	2006
9	Furio et al	ND	The presence of numerous intraparietal cysts, of varying size, diffuse in the varied colic segments, compatible with wall pneumatosis of the colon	ND	Multiple polypoid formations of varying sizes in the sigmoid, descending, ascending and cecum
	22
	2006
10	Miyagawa et al	Cystic radiolucencies in the colon	ND	Multiple numerous round polypoid lesions from the ascending colon to the sigmoid colon	Numerous round polypoid lesions from the ascending colon to the sigmoid colon
	23
	2006
11	Yasuoka et al	Noticeable gaseous distension of the small intestine	Free gas in the peritoneal cavity	ND	ND
	24
	2007
12	Maeda et al	Diffuse air shadows along the intestine suggesting gas accumulation in the bowel wall	Circumferential collections of air adjacent to the bowel lumen that ran parallel to the bowel wall	ND	ND
	25
	2007
13	Saito et al	Pneumoperitoneum with free air under the diaphragm and curvilinear radiolucency within the bowel wall	Intramural air in the ascending colon, and gas collection in the mesentery	ND	ND
	26
	2007
14	Our case	Small linear radiolucent gas collections along the wall of the colon	Intramural air in the sigmoid colon, and free gas in the peritoneal cavity around the sigmoid colon	ND	Multiple smooth surfaced small hemispherical protrusions in the sigmoid colon
	2008

ND: Not done.