Pneumatosis intestinalis in solid organ transplant recipients

Abstract

Pneumatosis intestinalis (PI) is an uncommon medical condition in which gas pockets form in the walls of the gastrointestinal tract. The mechanism by which this occurs is poorly understood; however, it is often seen as a sign of serious bowel ischemia, which is a surgical emergency. Since the early days of solid organ transplantation, PI has been described in recipients of kidney, liver, heart, and lung transplant. Despite the dangerous connotations often associated with PI, case reports dating as far back as the 1970s show that PI can be benign in solid organ transplant recipients. This is an important observation, as operative intervention in these patients carries greater risk than surgical procedures in the general population. The higher operative risks in the transplant population are partly due to their immunosuppressed status and poor wound healing. Furthermore, no clear consensus exists on the optimal management of PI. Various treatment strategies such as bowel rest, antibiotics, and parenteral feeding have been implemented with similar levels of success. With the increasing use of solid organ transplantation, PI is being recognized with increasing frequency. In this review, we provide a summary of the incidence, presentation, diagnosis, and management of PI, particularly as it affects recipients of solid organ transplantation.

Pneumatosis Intestinalis in Adult Bilateral Lung Transplant Patients: A Single Institution Experience and Literature Review

“…Although the mechanism of PI in lung transplant recipients remains uncertain, 3 major theories have been put forth and include the mechanical, the bacterial, and the biochemical [ 1 , 7 ].The mechanical theory postulates that gas dissects into the bowel wall from increased intraluminal pressure or from increased mediastinal pressure in mechanically ventilated patients via the mediastinum. The bacterial theory suggests that gas-forming bacteria enter the submucosa through mucosal rents and produce gas within the bowel wall, while the biochemical theory suggests that carbohydrates are broken down by bacteria resulting in gas production which is then absorbed into the bowel wall.…”

Pneumatosis intestinalis in a patient with COVID-19

“…As a patient with a solid organ transplant and a patient on systemic steroids, he was at increased risk for PI. [14][15][16][17] The patient was on many antibiotics during ICU admission, which could have disrupted the microbiota of the gut, and disrupted bacterial flora is reported to play a role in the development of PI. 9 As stated above, the COVID-19 virus can invade the cells of the GI tract, potentially causing damage to the bowel wall integrity.…”

“…PI is a rare but known entity in solid organ transplant patients. 14 15 The majority of patients experience no symptoms or vague, mild symptoms, and most cases resolve with conservative management. 14 There is literature that suggests a relationship between PI and use of systemic corticosteroids.…”

“… 14 15 The majority of patients experience no symptoms or vague, mild symptoms, and most cases resolve with conservative management. 14 There is literature that suggests a relationship between PI and use of systemic corticosteroids. 15–17 Although GI symptoms have been reported since the beginning of the COVID-19 outbreak, to date, there is limited literature regarding the association of PI with the COVID-19 virus.…”

Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease

“…Gastrointestinal (GI) complications occur in up to 50% of recipients following lung transplantation (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Compared to other transplant indications, A1ATD is a risk factor for early post-transplant laparotomy (5).…”