Idiopathic Pneumatosis Intestinalis Requiring Decompressive Laparotomy

Area of Science:

• Gastroenterology
• Radiology
• Trauma Surgery

Background:

• Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are radiographic findings often associated with bowel ischemia.
• However, PI can also be linked to benign conditions, such as obstructive airway disease.
• This case examines PI and HPVG in the context of severe sepsis following spinal trauma.

Observation:

• A 36-year-old male with a history of alcohol abuse presented with a complete thoracic spinal cord transection.
• Following surgery, he developed sepsis with elevated WBC count and lactic acid.
• Abdominal CT revealed PI and HPVG, raising concerns for bowel ischemia.

Findings:

• Exploratory laparotomy showed distended small bowel but no evidence of ischemia or injury.
• Negative pressure therapy was applied due to inability to close the abdominal wall.
• A second-look laparotomy confirmed the absence of bowel injury or ischemia.

Implications:

• PI and HPVG are important radiographic indicators that warrant careful clinical correlation.
• Clinical status and patient presentation should guide operative management decisions.
• No direct association was found between spinal trauma and the development of PI or HPVG in this case.