Pneumatosis Cystoides Intestinalis of the right colon: EUS findings, interesting cause and feasibility of interesting treatment

Pneumatosis Cystoides Intestinalis (PCI) of the colon is a relatively rare condition. We report two cases of PCI of the right colon and EUS findings. In the first case, PCI was caused by Voglibose (alpha 1-glucosidase inhibitor) for treatment of diabetes mellitus, which is the fifth case in the Japanese literature and no case reports from outside Japan. In the second case, a submucosal tumor of PCI was shrunken by needle aspiration. This aspiration method may be feasible for acute relief of symptoms in colonic obstruction due to PCI.

Case 1: a 73-year-old male was referred for colonoscopy because of abdominal fullness for a three months' duration. The patient has had medication for angina pectoris and diabetes mellitus for about 20 years. He has taken Voglibose for 6 and a half years. Colonoscopy showed multiple submucosal hard lesions in the right colon, associated with a stenosis at the hepatic flexure. PCI was suggested and ascertained by EUS where multiple gas echoes were observed in the colonic wall. Withdrawal of Voglibose eliminated his symptoms after a few days. He started taking Voglibose again, and the same symptom developed. After he stopped taking Voglibose, he has been doing well.

Case 2: an asymptomatic 37-year-old male came to us for a follow-up colonoscopy. He was pointed out to have a polyp of the colon about 1 year ago. Colonoscopy showed multiple submucosal hard lesions in the right colon. Multiple gas echoes were shown on EUS. One of the large cysts was punctured and aspirated. The cyst reduced its size and shrunk.

Conclusion: EUS is useful for accurate diagnosis of PCI. Voglibose-induced PCI is extremely rare, but the knowledge about this is important because PCI can be eliminated by withdrawal of medication. Aspiration of gas is a feasible treatment option for instant relief of symptoms in colonic obstruction due to PCI.