Pneumatosis Intestinalis: A Case Report and Approach to Management

Abstract

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

The Dilemma of Pneumatosis Intestinalis with Pneumoperitoneum: Nonoperative or Surgical Management—Analysis of a Case

“…PI is an uncommon condition which has recently arisen to clinical attention thanks to improved radiographic identification, with an incidence of 0.37% in patients submitted to abdominal CT scans [2]. The actual PI incidence is unknown due to its frequent asymptomatic course.…”

A rare case of segmental small bowel pneumatosis intestinalis: A case report

“…The location of the disease can act as a good guide to the aetiology with proximal disease usually being secondary to pyloric stenosis, gastric malignancy or ulcers whereas distal disease may be as a result of diverticulitis or mesenteric ischaemia. 9 Most reports of PI describe continuous portions of diseased bowel secondary to an intramural disease process or a mechanical obstruction. Interestingly, segmental disease as was seen in our case is rarely found.…”

“…In view of this, features of low-flow vascular states such as sepsis, congestive heart failure, use of ionotropic agents, and other causes of hypotension in the acute setting should lead to a high index of suspicion for ischaemic bowel and a low threshold for surgery. 9 Conservative management involving nasogastric bowel decompression maybe appropriate if a serious underlying cause of the PI has been excluded. 12 However, with high associated mortality rates of between 22 and 50% non-surgical management should be used with caution.…”

Pneumatosis intestinalis with extensive intrahepatic portal venous gas secondary to intra-abdominal sepsis: a rare occurrence

“…PI is a rare radiological finding resulting from gas cysts accumulating within the bowel wall 1. An array of aetiologies exist including underlying disease, medication and trauma 2.…”