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Pneumatosis cystoides coli in a patient with stage IV diffuse large B-cell lymphoma

Gabriel Atan Sanchez1, Andrew Michael Thompson1

  • 1Surgical Unit, Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia.

Journal of Surgical Case Reports
|February 15, 2023
PubMed

Insights

A patient with a history of lymphoma and bone marrow transplant experienced rectal bleeding and fever. Imaging revealed pneumatosis cystoides intestinalis, a rare condition of gas cysts in the colon.

Area of Science:

  • Gastroenterology
  • Oncology
  • Hematology

Background:

  • A 49-year-old female with a history of stage IV diffuse large B-cell lymphoma and graft-versus-host disease post-bone marrow transplant presented with acute symptoms.
  • The patient had undergone a bone marrow transplant, a significant factor in her complex medical history.

Observation:

  • Presented with a 12-hour history of painless per rectal bleeding and fever.
  • Physical examination revealed a soft, distended abdomen.
  • Laboratory results indicated thrombocytopenia and hypokalaemia.

Findings:

  • Computed tomography (CT) of the abdomen and pelvis demonstrated pneumatosis cystoides coli, gas-filled cysts within the colon wall, extending from the ileocaecal junction to the mid-transverse colon.
  • The CT findings were described as bizarre, highlighting the unusual presentation of this condition.

Implications:

  • Pneumatosis cystoides coli can present with diverse gastrointestinal symptoms, including rectal bleeding.
  • Management in this case was conservative, focusing on supportive care including intravenous antibiotics, fluid resuscitation, and electrolyte correction.
  • This case underscores the importance of considering rare gastrointestinal pathologies in immunocompromised patients with complex histories.

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