Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2008; 14(20): 3273-3275
Published online May 28, 2008. doi: 10.3748/wjg.14.3273
Pneumatosis cystoides intestinalis after fluorouracil chemotherapy for rectal cancer
Kenji Mimatsu, Takatsugu Oida, Atsushi Kawasaki, Hisao Kano, Youichi Kuboi, Osamu Aramaki, Sadao Amano
Kenji Mimatsu, Takatsugu Oida, Atsushi Kawasaki, Hisao Kano, Youichi Kuboi, Osamu Aramaki, Department of Surgery, Social Insurance Yokohama Central Hospital, Kanagawa 231-8553, Japan
Sadao Amano, Department of Surgery, Nihon University School of Medicine, Tokyo 173-0032, Japan
Author contributions: Mimatsu K, Oida T, Kawasaki A, Kano H, Kuboi Y and Aramaki O carried out the operation and were consultant overseeing the patient’s care; Mimatsu K wrote the manuscript; Amano S was responsible for drafting the manuscript and revising it critically.
Correspondence to: Kenji Mimatsu, MD, Department of Surgery, Social Insurance Yokohama Central Hospital, 268 Yamashita-cho Naka-ku Yokohama, Kanagawa 231-8553, Japan. mimatsu.kenji@yokochu.jp
Telephone: +81-45-6411921 
Fax: +81-45-6719872
Received: February 20, 2008
Revised: April 30, 2008
Accepted: May 6, 2008
Published online: May 28, 2008
Abstract

Pneumatosis cystoides intestinalis (PCI) is a relatively rare condition characterized by intraluminal gas in the gastrointestinal tract. Several chemotherapeutic agents have been reported to be associated with PCI, although fluorouracil-related PCI is extremely rare. We report a case of a 76-year old man who received adjuvant chemotherapy for rectal cancer with fluorouracil (FU) and leucovorin (LV). After 1 cycle of the treatment, he presented with diarrhea and abdominal pain. Abdominal radiogram revealed the presence of free air under the diaphragm and intramural gas in the intestine. Laparotomy was performed, showing a suspected diagnosis of perforation in the gastrointestinal tract. Intraoperative findings revealed pneumatosis of the intestine without evidence of perforation. He was treated supportively and his symptoms improved. In conclusion, we should consider the possibility of PCI occurring in patients with malignancies during chemotherapy treatment.

Keywords: Pneumatosis cystoides intestinalis, Chemotherapy, Fluorouracil, Colorectal cancer