7174 Diagnosis of pneumatosis cystoides intestinalis by endoscopic ultrasound.

Abstract

Background /Aim: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of submucosal or subserosal gas-containing cysts within the gastrointestinal wall. Idiopathic and secondary forms of PCI have been described. Although endoscopic and radiological findings may suggest PCI, differential diagnosis with other entities is mandatory to avoid misdiagnosis and inappropriate treatment. We assessed the value of Endoscopic Ultrasound (EUS) in the diagnosis of this condition. Methods /Results: A 69-year-old male was admitted at our department for rectal bleeding and diarrhea associated with lower abdominal pain. He had been submitted to a transrectal biopsy of the prostate demonstrating adenocarcinoma, and he received anti-androgenic treatment. Colonoscopy showed multiple polyp-like bluish masses protruding into the lumen of the sigmoid and descending colon, with some spared areas between affected segments. Barium enema demonstrated multiple filling defects with a large base. Endoscopic Ultrasound with a radial scanning echoendoscope at 7.5 and 12 MHz showed gas-containing cystic lesions in the submucosa of the colon. Conclusions: Differential diagnosis of PCI with other entities on the basis of radiographic and endoscopic findings alone may not always be easy. Endoscopic ultrasound can be used to characterize the contents of the intestinal cysts. Demonstration of gas within the submucosa definitely establishes the diagnosis, without the need to puncture the cysts.