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Updated: Oct 1, 2025
05:07
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
773
Pneumatosis intestinalis: Not always bowel ischemia
Adele Hwee Hong Lee1, Shanthapriya Tellambura2
1Department of General Surgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
Radiology Case Reports
|March 4, 2022
Summary
Pneumatosis intestinalis, or intramural gas, often indicates bowel ischemia requiring surgery. However, this case shows fecal impaction can mimic this, highlighting the need for clinical correlation to avoid unnecessary interventions.
Area of Science:
- Gastroenterology
- Radiology
- Emergency Medicine
Background:
- Pneumatosis intestinalis (intramural gas) typically signals bowel ischemia, often requiring surgical intervention.
- Radiological findings of intramural gas and free peritoneal gas can be concerning for surgical emergencies.
Observation:
- An 82-year-old female presented with hypotension and nausea, exhibiting extensive submucosal gas in the small bowel and free peritoneal gas on CT scan.
- The patient had a complex medical history including chronic lymphocytic leukemia, stroke, and rheumatoid arthritis.
Findings:
- Radiological diagnosis suggested acute bowel ischemia.
- Despite imaging findings, the patient's stable clinical status led to a final diagnosis of fecal impaction.
- This case underscores the importance of clinical correlation in interpreting pneumatosis intestinalis.
Implications:
- Accurate diagnosis of pneumatosis intestinalis is crucial to differentiate between surgical emergencies and benign conditions.
- Over-reliance on imaging without clinical correlation can lead to unnecessary surgeries and patient harm.
- Close clinical monitoring is vital for managing patients with suspected bowel ischemia presenting with pneumatosis intestinalis.
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