Pneumatosis Cystoids Intestinalis in an Immunosuppressed Patient

We report the case of a 59 year old woman who presented to the emergency room with a four day history of abdominal pain worsening over the last 24 hours. She had previously been diagnosed with Alport’s syndrome and had undergone an unrelated donor renal transplant in August 2001. She was on several immunosuppressants. There was some evidence of peritoneal signs on physical exam. Plain film X-ray and CT scan revealed marked pneumatosis intersinalis of the right and transverse colon. The patient underwent a laparotomy. The laparotomy showed crackly air throughout the serosa of the right and transverse colon, which was also pale in appearance. A subtotal colectomy and ileostomy was performed to correct the PCI and perforation. The patient had a successful recovery post-surgery. The success of surgical intervention in our case demonstrates the potential role for surgery in a patient with suspected PCI, with evidence of perforation.