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

Katha H Dave1, Sagar J Vaghela1, Archana D Dalal1

  • 1Department of General Surgery, Smt. NHL Municipal Medical College, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR), Ahmedabad, Gujarat, India.

Journal of the West African College of Surgeons
|July 14, 2026
PubMed
Abstract

Insights

Pneumatosis intestinalis (PI) is a rare bowel condition. Early recognition and conservative management for PI without ischemia improve survival, while surgical intervention for ischemic PI carries high mortality risks.

Area of Science:

  • Gastroenterology
  • Radiology
  • Abdominal Surgery

Background:

  • Pneumatosis intestinalis (PI) is a rare condition, affecting 0.03% of patients, characterized by gas in the bowel wall.
  • PI is classified into primary (benign) and secondary (pathological) types, with secondary PI being more common.
  • Diagnosis is typically radiological, and management ranges from conservative to surgical.

Purpose of the Study:

  • To raise clinician awareness of pneumatosis intestinalis as a critical differential diagnosis in acute abdominal pain.
  • To highlight the importance of early recognition and appropriate management strategies for PI.

Main Methods:

  • A retrospective observational study of 10 patients with acute abdominal pain and radiological diagnosis of PI via contrast-enhanced computed tomography (CECT) abdomen.
  • Patients were treated conservatively or surgically based on clinical presentation and CECT findings.

Main Results:

  • 60% of patients presented with severe abdominal pain, 60% required surgical intervention, and 20% mortality was observed despite surgery.
  • Conservative management with IV fluids, antibiotics, and analgesics resulted in survival for all patients.
  • Histopathology revealed gangrenous changes and vascular occlusion in severe cases; conservative survivors showed no long-term complications.

Conclusions:

  • Early recognition of PI is crucial for improving patient outcomes.
  • Surgical intervention is indicated for PI with evidence of ischemia on CECT, though mortality remains high.
  • Conservative management is effective for PI patients with long-term symptoms and healthy bowels.
Keywords:
Bowel ischaemiaexploratory laparotomyintestinal gasnecrosispneumatosis intestinalisvascular occlusion

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