Pneumatosis intestinalis (PI) is a
rare disease that forms
emphysema lesions under the mucosa and serosa of the gastrointestinal tract. We present the first case of PI following radiation-induced
esophagitis during
chemoradiotherapy (CRT) for
lung cancer. A 74-year-old man with severe
chronic obstructive pulmonary disease (
COPD) was treated with CRT for
lung cancer. During the treatment, he presented with
vomiting and abdominal distention. CT showed pneumatosis from the esophagus to the small intestine. Severe radiation-induced
esophagitis was observed, and gastrointestinal endoscopy revealed a circumferential esophageal
ulcer. From these observations, this case was diagnosed as PI following severe
esophagitis. A nasogastric tube was inserted, and
conservative treatment with fasting, fluid replacement, and
antibiotic was performed. Four days after the onset of PI, CT showed marked improvement of the pneumatosis. When CRT is performed for
lung cancer patients, we should not only consider
esophagitis but also PI. The presence of
COPD may be considered a specific factor for the development of severe
esophagitis and the consequent PI in this case.