Pneumatosis Intestinalis: Identifying the Need for Surgery for Gas in the Gut Wall and Outcomes

Pneumatosis intestinalis (PI) is a rare (0.03%) pathology defined as the presence of gas within the small or large bowel wall. It was first described by Du Vernoi in autopsy studies in 1730. There are two types of PI: primary (15% cases) with benign and cystic intramural gas and secondary (85% cases) having a linear collection of gas reflecting an underlying pathology. It is usually diagnosed radiologically. Management of PI varies from conservative to emergency surgical intervention.

We report this study to make the clinicians aware about this rare, but important differential diagnosis in patients who present with acute abdominal pain.

This retrospective observational study includes 10 patients who presented with acute abdominal pain to the emergency department of a tertiary care hospital over a span of 24 months. Patients with radiological diagnosis of PI on contrast-enhanced computed tomography (CECT) abdomen were selected for the study.

All patients presented with severe abdominal pain; 60% had abdominal distension, and 40% showed signs of peritonitis and septic shock. Surgical management was needed in 60%, and the rest were treated conservatively with intravenous fluids, antibiotics and analgesics. About 20% patients could not survive despite surgery. All patients managed conservatively survived. Histopathological reports showed gangrenous changes of intestinal walls with vascular occlusion. Patients who have survived came for regular follow-up and does not show any complications.

PI, though rare, must be recognized early to improve outcomes. Surgical intervention is necessary in cases with ischaemia on CECT abdomen. They have high mortality rates even after surgical intervention. Patients having long-term onset of symptoms with healthy bowels can be managed conservatively.