Benign pneumatosis intestinalis after bilateral lung transplantation

Abstract

This series details two cases of benign pneumatosis intestinalis (PI) in patients post-lung transplant, which were discovered incidentally on routine surveillance chest radiographs during ambulatory clinic visits. Both patients had uneventful post-transplant recovery and were asymptomatic at presentation. The patients were admitted for observation. Contrast-enhanced abdominal CT scans confirmed the plain film findings. Both cases were managed conservatively with bowel rest, intravenous hydration and serial abdominal examinations. The patients had unremarkable hospital courses and were both discharged in good condition. Our current understanding of benign PI in patients post-transplant is limited to a few case series and case reports. Greater awareness of this entity may decrease unnecessary invasive procedures and improve management of these patients.

Figure 1

Posteroanterior chest radiograph showing large amount of pneumoperitoneum subjacent to the diaphragm (thick arrows) and bowel with mottled appearance (thin arrows).

Figure 2

Upright abdominal radiograph showing extensive pneumatosis intestinalis along entire ascending colon (thick arrows) and also pneumoperitoneum under the diaphragm and along the right paravertebral region, likely extending into the retroperitoneum (thin arrows).

Figure 3

Coronal CT image showing extensive pneumatosis intestinalis along entire ascending colon, with right-sided intraperitoneal and retroperitoneal free air (arrows).