The Spectrum of Pneumatosis Intestinalis

Abstract

A review of the spectrum of illness associated with pneumatosis intestinalis enables us to identify the probable causes of, the best diagnostic approaches to, and the most appropriate treatments for this condition. Data Sources: A review of all published material in the English language regarding pneumatosis intestinalis was conducted using the PubMed and MEDLINE databases. Any relevant work referenced in those articles and not previously found or published before the limit of the search engine was also retrieved and reviewed.Study Selection: There were no exclusion criteria for published information relevant to the topic. All of the studies cited in the present review make a point that contributes to the portrayal of this condition. In circumstances in which the same point was made in several different studies, not all were cited herein.Data Extraction: All published material on pneumatosis intestinalis was considered. Information was extracted for preferentially selected ideas and theories supported in multiple studies.Data Synthesis: The collected information was organized by theory.Conclusions: Mucosal integrity, intraluminal pressure, bacterial flora, and intraluminal gas all interact in the formation of pneumatosis intestinalis. Radiography and computed tomography are the best diagnostic tests. Nonoperative management should be pursued in most patients, and underlying illnesses should be treated. When acute complications appear, such as perforation, peritonitis, and necrotic bowel, surgery is indicated.

Medical management of pneumatosis intestinalis in patients undergoing allogeneic blood and marrow transplantation

“…21 This conservative approach to PI management, consisting of non surgical management initially compared favorably with historical mortality rates of 35-75% when many cases were managed with a surgery. [22][23][24] The majority of our patients died of GI GvHD or other GI complications suggesting that PI represents a poor prognostic factor. Surveillance for PI in the setting of GI GvHD may be indicated for patients with prolonged treatment with immunosuppressive therapy, especially glucocorticoids.…”

An unusual case of air within the bladder wall: Bladder pneumatosis?

“…For example, in cases involving bowel obstruction, the cystic lesions are more commonly located distally to obstructive lesions rather than being located more proximally. 4,7,8 A combination of both theories might play a role in the pathogenesis of this case; on one hand , mechanical forces, especially increased intraluminal pressure and increased peristalsis as a result of constipation; on the other hand , air from ruptured alveoli might dissect along vessels and lymphatic channels reaching the bladder.…”

Pneumatosis cystoides coli of the ascending colon: colonoscopic and CT colonographic features

“…tions parallel to the bowel wall [3]. CT scans can also detect bowel changes and their associated conditions.…”