図５〜図８で下行結腸（D）は虚脱し，上行結腸（A）は拡張しているので，その間に閉塞病変がないか図５の１から肛門側へ追跡すると，図４の９から図５の↑の病変に連続する，その図５〜図７の↑は中心部に虚脱した内筒と，血管を含む脂肪組織（白矢印：中筒と外筒による圧排から虚血状態となり，浮腫を生じ濃度がやや上昇している）を認め腸重積である．図８と図７の▲が重積の誘因となる病変と思われるが，造影効果が強く悪性腫瘍の可能性を考慮する．図７〜図１６の△は壁内気腫であり，壊死または高度の虚血状態を意味することが多い．さらに図１７で盲腸の最大径は12cm程あり，穿孔の危険性は極めて高いと解釈すべきである．図１で，腎静脈が合流する直上のIVCは大動脈よりかなり縮小しており，強い脱水状態を示唆する．上記診断で緊急手術を行った．横行結腸で腸重積を認め，盲腸から上行結腸は暗赤色に虚血状態を呈していた．横行結腸癌による腸重積であった．

文献考察１）：壁内気腫は必ずしも腸管壊死を意味しない．
AJR Am J Roentgenol. 2004 Dec;183(6):1667-71.
Cecal pneumatosis in patients with obstructive colon cancer: correlation of CT findings with bowel viability.
Taourel P, Garibaldi F, Arrigoni J, Le Guen V, Lesnik A, Bruel JM.
OBJECTIVE: The purpose of our study was to reassess CT findings of cecal pneumatosis in patients with acute large-bowel obstruction due to colon cancer to determine whether this condition indicates transmural necrosis versus viable bowel and also whether other CT findings could be used to identify patients with transmural necrosis. CONCLUSION: CT findings of cecal pneumatosis do not always indicate transmural infarction in patients with acute large-bowel obstruction due to colon cancer. Cecal pneumatosis may be related to viable bowel when it displays a bubblelike pattern or when it is not associated with other findings of ischemia.PMID: 15547208

文献考察２）：門脈内ガスを伴う壁内気腫は腸管壊死の可能性が高い．
AJR Am J Roentgenol. 2003 Mar;180(3):733-6.
Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel.
Kernagis LY, Levine MS, Jacobs JE.
OBJECTIVE: The purpose of our study was to reassess the CT finding of pneumatosis in intestinal ischemia to determine whether it indicates transmural necrosis versus partial mural ischemia and also to determine whether other CT findings can be used to predict which patients with pneumatosis are likely to have viable bowel. CONCLUSION: The CT finding of pneumatosis does not always indicate transmural infarction of the bowel in intestinal ischemia. Patients with associated portomesenteric venous gas are more likely to have transmural infarction than those with pneumatosis alone.PMID: 12591685