Pneumatosis intestinalis: not always a surgical indication

Abstract

We present a case of pneumatosis intestinalis (PI) of the colon in the setting of inflammatory bowel disease that was treated with medical management rather than emergent surgery. While the reflex response to extraluminal air in the abdomen is abdominal exploration, consideration of the clinical context in which PI is discovered and an understanding of a complete differential diagnosis of the sources of PI is critical to avoiding unnecessary surgery.

Figure 1

(a) CT scan of the abdomen 2 days following high-dose intravenous steroids shows extensive PI of right colon. Intramural gas tracking is visualized parallel to the bowel mucosa in the ascending and transverse colon. (b) Repeat CT scan after 3 days bowel rest and tapering of steroids and shows resolution of PI. No evidence of intramural gas along the colonic mucosa is seen.