Pneumatosis Cystoides Coli Presenting as Acute Abdomen in a Patient with Complicated Behcet’s Disease: A Case Report

Abstract

Patient: Male, 40-year-old

Final Diagnosis: Pneumatosis cystoides coli

Symptoms: Abdominal pain • acute abdomen • anorexia

Medication: —

Clinical Procedure: Exploratory laparotomy • ileostomy placement • right hemicolectomy

Specialty: Gastroenterology and Hepatology • Rheumatology • Surgery

Objective:

Rare disease

Background:

Behcet’s disease (BD) is defined as vasculitis involving arteries and veins of any size and affecting almost any organ system. Abdominal manifestations of BD are diverse and nonspecific. Mucosal ulcerations can be seen in the gastrointestinal tract. Extensive ulcerations, especially ileocecal lesions, can lead to perforation, strictures, fistulas, and abscesses. Pneumatosis cystoides intestinale is a rare benign condition characterized by multiple submucosal or subserosal, gas-filled cysts in the gastrointestinal tract wall. Pneumatosis cystoides coli (PCC) affects the colon, can present with a wide range of manifestations, and can mimic many different systemic diseases. We describe a case of PCC in a patient with Behcet’s disease who presented to the Emergency Department with a clinical suspicion of acute abdomen.

Case Report:

A 40-year-old man with complicated Behcet’s disease, treated with high-dose steroids, presented with acute abdomen and CT scan findings highly suggestive of intestinal obstruction due to ileocolic intussusception. He underwent laparoscopic right hemicolectomy. Pathology demonstrated PCC disease.

Conclusions:

Pneumatosis cystoides coli can present with a broad range of symptoms and can be secondary to many systemic and autoimmune diseases. With radiological evidence and a high level of suspicion, unnecessary surgery can be prevented.