[Pneumatosis Cystoides Intestinalis, As a Rare Complications of Coeliac Disease]

Intestinal pneumatosis cystoides is rarely diagnosed clinical entity characterized by multiple gas containing cysts inside the wall of the gastrointestinal tract. Primary (15%) and secondary (85%) forms are known. In the more frequent secondary forms small intestine and the right side of the colon are mainly affected, and the underlying pathology can be gastrointestinal, pulmonary or immunological. The 64 year old male patient reported by the authors showed clinical signs of severe malabsorption (his body weight: 47,5 kg, height: 178 cm, BMI: 15). The intestinal pneumatosis was diagnosed by exploration performed because of suspected perforation (pneumoperitoneum). Due to severe malabsorption the patient was admitted to Gastroenterological Department. Duodenoscopy and small bowel biopsy was performed. Small intestinal histology and presence of anti-gliadin and anti-endomysium antibody confirmed the suspected diagnosis of coeliakia. Parenteral nutrition, special gliadin free diet, hyperbaric oxygen inhalation, steroid, and metronidazole treatment resulted in a gradual improvement in the nutritional and general condition of the patient. After one year the patient is without complaints, he gained 24,5 kg body weight BMI: 22,5). The author's case points to a rare serious complication of non-treated coeliakia. Recognition of intestinal pneumatosis in time could have prevented surgical intervention in the high risk patient.