Severe pneumatosis intestinalis with portal venous gas

69 Sir, An 81‐year‐old man who had habitual constipation visited our hospital complaining of vomiting. His abdomen showed distension without tenderness. Abdominal X‐ray showed dilatation of stomach, with gas in the small and large intestines [Figure 1]. Computed tomography revealed numerous gas cysts in the wall of stomach, small and large intestines [Figure 2, arrows], and portal venous system [Figure 2]. He was diagnosed with severe pneumatosis intestinalis with portal venous gas. Despite intensive care including antibiotic agents and infusions, he died several hours after visiting the hospital. This is a rare case of pneumatosis intestinalis because not only part of the intestine was involved, as previously reported,[1] but also the whole intestine and the stomach. The pathogenesis of pneumatosis intestinalis is considered to be complex and multifactorial.[2] In this case, increased pressure on the intestinal lumen by habitual constipation may have contributed to the development of pneumatosis intestinalis.