Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Gas filled cysts in the wall of the intestine and mesentery• May be primary and idiopathic; an incidental finding; or secondary to chronic obstructive pulmonary disease, infectious gastroenteritis, or connective tissue disorders• Fulminant pneumatosis is associated with bacterial infection and necrosis of the bowel wall. +++ Epidemiology + • Characterized by gas-filled cysts in the wall of the gut and mesentery• 15% of cases are primary and idiopathic• Secondary pneumatosis comprises 85% of cases; cysts may be located anywhere in the GI tract• Conditions that underlie secondary pneumatosis intestinalis include:-Inflammatory bowel disease-Infectious gastroenteritis-Corticosteroid therapy-Connective tissue disorders-Intestinal obstruction-Diverticulitis-Chronic obstructive pulmonary disease-Acute leukemia-Lymphoma-AIDS-Organ transplantation• Fulminant pneumatosis is associated with acute bacterial infection and necrosis of the bowel wall, usually associated with intestinal infarction; pneumoperitoneum is sometimes present +++ Symptoms and Signs + • Abdominal discomfort• Diarrhea• Passing of excessive amounts of gas• Abdominal distention• Abdominal tenderness +++ Laboratory Findings + • Nonspecific in most cases• When associated with intestinal necrosis:-Leukocytosis-Metabolic acidosis-Increased serum lactate +++ Imaging Findings + • Abdominal x-rays and CT scan: Linear gas deposits in the intestinal wall; if perforation is present, free air may be visualized + • Pneumatosis intestinalis may be an incidental finding (primary and most cases of secondary pneumatosis) or indicative of bowel wall necrosis with gas produced by invading bacteria +++ Rule Out + • Intestinal ischemia• Strangulation obstruction + • Abdominal x-ray or CT scan +++ When to Admit + • Suspected intestinal necrosis + • Primary and secondary pneumatosis: No specific treatment; oxygen administration may lead to resolution• Fulminant pneumatosis: Bowel resection +++ Surgery +++ Indications + • Intestinal necrosis• Intestinal ischemia• Strangulation obstruction +++ Contraindications + • Idiopathic pneumatosis• Secondary pneumatosis associated with systemic disease without bowel necrosis +++ Medications + • Oxygen administration +++ Complications + • Perforation if associated with necrosis• Sepsis +++ Prognosis + • Primary and secondary: Excellent• Fulminant: High mortality related to intestinal necrosis +++ References ++Deniz K et al: Intestinal involvement in Wegenerâs granulomatosis. J Gastrointestin Liver Dis 2007;16:329. [PubMed: 17925931] ++Ebert EC: Gastric and enteric involvement in progressive systemic sclerosis. J Clin Gastroenterol 2008;42:5. [PubMed: 18097282] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth