Pneumatosis Intestinalis

• • 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