J Korean Diabetes.  2014 Mar;15(1):45-50. 10.4093/jkd.2014.15.1.45.

A Case of Pneumatosis Cystoides Intestinalis and Portal Venous Gas Accompanied by Emphysematous Pyelonephritis in Type 2 Diabetes Mellitus

• Yu SH
• Eom YS
• Lee DM
• Lee S
• Kim YS
• Lee KY
• Kim BJ
• Kim KW
• Park IB

• KMID: 1703383
• DOI: http://doi.org/10.4093/jkd.2014.15.1.45

Abstract

Diabetes mellitus is a major risk factor for urinary tract infection (UTI); emphysematous pyelonephritis (EP), a complication of UTIs, often occurs in patients with underlying, poorly controlled diabetes mellitus. We report the case of an 87-year-old woman with EP in type 2 diabetes mellitus who developed pneumatosis cystoides intestinalis (PCI) with portal venous gas. PCI is a radiographic finding, which is found in a linear or cystic form of gas in the submucosa or subserosa of the bowel wall. PCI has two common presentations. Primary PCI is a benign idiopathic condition. Secondary PCI is associated with a wide variety of gastrointestinal and non-gastrointestinal diseases. PCI with portal venous gas in particular is associated with ischemic gastrointestinal disease. Initial pre-enhanced abdominopelvic computed tomography showed EP in the right kidney without PCI. Newly occurring PCI and hepatic portal venous gas were found in the right ascending colon after EP improved. This is a rare case of PCI accompanied by emphysematous pyelonephritis in type 2 diabetes mellitus. The patient's general condition improved with intravenous antibiotics and fluid therapy without a surgical approach. However, she was discharged without further treatment because the family refused any further evaluations and treatments.

Keyword

Pneumatosis cystoides intestinalis; Pyelonephritis; Diabetes mellitus

MeSH Terms

Aged, 80 and over
Anti-Bacterial Agents
Colon, Ascending
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Female
Fluid Therapy
Gastrointestinal Diseases
Humans
Kidney
Pneumatosis Cystoides Intestinalis*
Pyelonephritis*
Risk Factors
Urinary Tract Infections
Anti-Bacterial Agents

Figure

• 

  Fig. 1. Pre-enhanced abdominopelvic computed tomography showed intraparenchymal, intracalyceal and intrapelvic mottled air densities in the right kidney.

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  Fig. 2. Pneumatosis cystoides intestinalis (PCI), portal venous gas and mesenteric venous gas were newly observed in pre-enhanced abdominopelvic computed tomography. (A) The air densities in the right kidney have nearly disappeared. (B) Portal venous gas (arrow). (C) Air density within the superior mesenteric vein and the mesenteric vessels (arrow). (D) PCI in the wall of the right ascending colon (arrow).

Reference

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