Pneumatosis cystoides intestinalis following voglibose therapy

Figure

a) Computed tomography showed multiple grape-like accumulations of gas in the ascending and descending colon (white arrows); b) Colonoscopy revealed multiple nodular protrusions in the colon (indigo carmine staining).

A 56-year-old man with type 2 diabetes developed abdominal distension after 3 months of voglibose therapy (an alpha-glucosidase inhibitor similar to acarbose, known to cause flatulence). A computed tomography (CT) scan revealed intramural gas in the colon (Figure a, arrows). Colonoscopy revealed multiple smooth, cystic nodules in the colon (Figure b). One lesion collapsed after a deep biopsy, confirming a diagnosis of pneumatosis cystoides intestinalis (PCI). The patient’s symptoms resolved after discontinuing voglibose. Follow-up colonoscopy 1 year later demonstrated resolution of the lesions. PCI is a rare condition characterized by gas accumulation within the submucosa or subserosa of the gastrointestinal tract. It may be associated with factors such as intestinal surgery, certain medications (e.g., alpha-glucosidase inhibitors), or pulmonary diseases. The condition generally has a favorable prognosis and should not be mistaken for intestinal perforation, in order to avoid unnecessary surgical interventions

Yuan-Lu Shan M. Med., The First Affiliated Hospital of Wenzhou Medical University, Department of Anesthesiology Wenzhou, China

Wen-Xiu Lin M. Med., The First Affiliated Hospital of Wenzhou Medical University, Department of Radiology Wenzhou, China

Wei Xie M. Med., The First Affiliated Hospital of Wenzhou Medical University, Department of Gastroenterology Wenzhou, China, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Cite this as: Shan YL, Lin WX, Xie W: Pneumatosis cystoides intestinalis following voglibose therapy. Dtsch Arztebl Int 2026; 123: 114. DOI: 10.3238/arztebl.m2025.0168