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


Dr Gabriel Atan Sanchez, Dr William Macfaul, Dr Steven Schlichtemeier

Summary

A 49-year-old female with a background of stage IV diffuse large B-cell lymphoma and subsequent graft-versus-host disease from a bone marrow transplant. 

Presented to a rural referral hospital in New South Wales, Australia with a 12-hour history of 4-5 episodes of painless per rectal (PR) bleeding and fever. On examination she had a soft, but distended abdomen.

Laboratory investigations revealed thrombocytopenia [26 x10^9/L] ad hypokalaemia [2.9 mmol/L]. Following a computed tomography (CT) of her abdomen and pelvis, it was found that she had pneumatosis cystoides coli ranging from the ileocaecal junction to the mid-transverse colon. Given her benign abdominal examination, her management was initially supportive with intravenous antibiotics, intravenous fluid resuscitation and correction of electrolyte abnormalities. 

Given the unusual CT appearance and the rarity of the condition, we felt that this case was worthy of discussion.