Pneumatosis intestinalis: Not always bowel ischemia

Abstract

Pneumatosis intestinalis or abnormal intramural gas within the digestive tract usually suggests bowel ischemia necessitating urgent surgery. We report the case of an 82-year-old female presenting with hypotension and nausea, with a past history of schizophrenia, low grade chronic lymphocytic leukemia, stroke, bronchitis and rheumatoid arthritis. Computed tomography performed demonstrated extensive submucosal gas within the entire small bowel, associated with free gas in the peritoneal cavity. Bowel ischemia was diagnosed radiologically. However, a benign diagnosis of fecal impaction was ultimately made due to the patient's stable clinical status. Clinical correlation and close monitoring of clinical status in this context is of greatest diagnostic assistance when encountered with this phenomenon, to prevent unnecessary harm to the patient.

Keywords: Conservative treatment; Fecal impaction; Gastrointestinal disease; Ischemia; Mesenteric ischemia; Radiography.

Fig. 1

Abdominal x-ray demonstrating marked distension of small bowel loops (yellow arrows) with gas in the submucosal plane (white arrow).

Fig. 2

Computed tomography of the abdomen and pelvis demonstrating extensive submucosal air within the entire small bowel (yellow arrows), associated with free gas in the peritoneal cavity (white arrow). (A) Axial view. (B) Coronal view.