History and clinical findings: A 56-year-old man was admitted to hospital for investigation of meteorism and severe flatulence for 10 months and irregular stools. He had no previous illness. On examination his abdomen was quite distended, with very active but low-pitched peristalsis.
Investigation: Plain x-ray of the abdomen showed multiple round translucencies along the wall of the left hemicolon. Coloscopy revealed multiple firm-walled cysts in the descending and sigmoid colon which contained H2 in high concentration. Histologically there was slight inflammatory infiltration of the submucosa as well as some slit-like hollow spaces, pointing to the diagnosis of pneumatosis cystoides intestinalis. The H2 breath test, done to confirm the diagnosis, indicated increased H2-concentration, both on fasting and after lactulose.
Treatment and course: A diet low in flatulence-producing carbohydrates satisfactorily controlled the symptoms, but the local findings remained unchanged over 4 years.
Conclusion: Pneumatosis cystoides intestinalis should be included in the differential diagnosis of meteorism and flatulence. Diet can satisfactorily control the symptoms of this rare disease.