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Radiol Clin North Am 2021 Jul;59(4):647-660

Department of Radiology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.

A wide spectrum of incidental bowel findings can be seen on CT, including but not limited to, pneumatosis intestinalis, diverticular disease, non-obstructive bowel dilatation, transient small bowel intussusception, and submucosal fat. Radiologists should be aware that such findings are almost always benign and of little clinical significance in the absence of associated symptoms. Conversely, vigilance must be maintained when evaluating the bowel, because malignant neoplasms occasionally come to clinical attention as incidental imaging findings. Read More

J Oncol Pharm Pract 2021 May 30:10781552211015776. Epub 2021 May 30.

Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.

Introduction: Pneumatosis intestinalis is characterized by air in the subserosal or submucosal layer of the intestine, with the severity ranging from mild and asymptomatic to symptomatic with serious conditions such as intestinal ischemia and perforation requiring surgery. Although several etiologies, including those from conventional chemotherapy agents and molecular target agents, have been suggested, blinatumomab-related pneumatosis intestinalis is quite rare.

Case Report: An 11-year-old girl with history of B-cell ALL presented with bone marrow relapse 3 years after completion of initial chemotherapy. Read More

Diagn Interv Imaging 2021 May 21. Epub 2021 May 21.

Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France.

Purpose: The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference.

Materials And Methods: Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25-93 years). Read More

Emerg Radiol 2021 May 22. Epub 2021 May 22.

Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy.

Purpose: To assess the incidence of erroneous diagnosis of pneumatosis (pseudo-pneumatosis) in patients who underwent an emergency abdominal CT and to verify the performance of imaging features, supported by artificial intelligence (AI) techniques, to reduce this misinterpretation.

Methods: We selected 71 radiological reports where the presence of pneumatosis was considered definitive or suspected. Surgical findings, clinical outcomes, and reevaluation of the CT scans were used to assess the correct diagnosis of pneumatosis. Read More

IDCases 2021 30;24:e01134. Epub 2021 Apr 30.

Division of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.

infection is known to cause Lemierre's syndrome, not pelvic peritonitis. Herein, we report a case of pelvic peritonitis and bacteremia, without Lemierre's syndrome, mimicking intestinal necrosis. A 28-year-old woman with peritoneal irritation and shock was suspected of having intestinal necrosis due to the presence of hepatoportal venous gas and pneumatosis intestinalis. Read More

J Surg Case Rep 2021 Apr 24;2021(4):rjab138. Epub 2021 Apr 24.

Department of General Surgery, AULSS 2 Marca Trevigiana, ospedale civile di Oderzo (TV), Italy.

Pneumoperitoneum refers to the presence of intraperitoneal free gas outside the viscera. A perforation of a hollow viscus is the main cause and usually indicates a surgical emergency. However, some case of pneumoperitoneum can be completely asymptomatic and secondary to benign conditions that do not require any surgical intervention. Read More

Surgery 2021 Apr 26. Epub 2021 Apr 26.

Departments of Radiology, Biomedical Informatics, and Bioengineering, University of Pittsburgh, PA. Electronic address:

Background: The radiographic finding of pneumatosis intestinalis can indicate a spectrum of underlying processes ranging from a benign finding to a life-threatening condition. Although radiographic pneumatosis intestinalis is relatively common, there is no validated clinical tool to guide surgical management.

Methods: Using a retrospective cohort of 300 pneumatosis intestinalis cases from a single institution, we developed 3 machine learning models for 2 clinical tasks: (1) the distinction of benign from pathologic pneumatosis intestinalis cases and (2) the determination of patients who would benefit from an operation. Read More

BMJ Case Rep 2021 Apr 22;14(4). Epub 2021 Apr 22.

Critical Care, Children's Mercy Hospital, Kansas City, MO, USA.

This case demonstrates pneumatosis intestinalis and small bowel perforation in a paediatric patient with multisystem inflammatory syndrome in children (MIS-C). Our patient presented with fever, abdominal pain and shortness of breath. She progressed to haemodynamic failure and small bowel perforation approximately 1 week after admission. Read More

ANZ J Surg 2021 Apr 6. Epub 2021 Apr 6.

Department of Surgery, Ome Municipal General Hospital, Tokyo, Japan.

Background: Several theories explaining the development of pneumatosis intestinalis (PI) have been reported, but a substantial portion of cases have been idiopathic. Additionally, predictors of bowel ischaemia in PI have not been fully investigated, while PI with bowel ischaemia has deteriorated overall outcomes of PI.

Methods: Sixty-four patients diagnosed with PI (2009-2019) were allocated to two groups: with (group 1; n = 15 (23%)) and without (group 2; n = 49 (77%)) bowel ischaemia. Read More

Clin J Gastroenterol 2021 Mar 27. Epub 2021 Mar 27.

Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.

Pneumatosis intestinalis (PI) occurs when gas is discovered in the intestinal wall and is categorized into two types: primary PI which is idiopathic and mainly occurs in the colon, and secondary PI which occurs more often in the small bowel but has variable presentation and etiology. We report a case of a patient status post-orthotopic deceased liver transplantation complicated by a portal vein thrombus on chronic lactulose for portosystemic encephalopathy who presented due to pyelonephritis and persistent diarrhea. The patient underwent colonoscopy with random biopsies and subsequently developed acute sepsis with Escherichia coli bacteremia. Read More

Int J Surg Case Rep 2021 Apr 13;81:105772. Epub 2021 Mar 13.

Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition, which can affect the entire gastro-intestinal tract. It can be idiopathic or most often secondary to various diseases. The causes remain multiple and the stenosing peptic ulcer is one of them. Read More

J Med Case Rep 2021 Mar 2;15(1):109. Epub 2021 Mar 2.

Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain.

Background: Pneumatosis intestinalis (PI) is a rare entity which refers to the presence of gas within the wall of the small bowel or colon which is a radiographic sign. The etiology and clinical presentation are variable. Patients with PI may present either with chronic mild non-specific symptoms or with acute abdominal pain with peritonitis. Read More

Dtsch Arztebl Int 2020 Dec;117(51-52):877

Clin Imaging 2021 Feb 9;76:104-108. Epub 2021 Feb 9.

Department of Radiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, United States; Huron Valley Radiology, Ypsilanti, MI, United States.

Pneumatosis intestinalis is a potential cause of asymptomatic pneumoperitoneum without peritonitis. The disease can be managed conservatively and presents a clinical scenario where pneumoperitoneum does not necessitate surgical management. This case illustrates the importance of acknowledging the condition and its variable presentation, allowing for increased awareness and avoidance of invasive procedures when not indicated. Read More

BMJ Case Rep 2021 Jan 27;14(1). Epub 2021 Jan 27.

Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, The Republic of Korea

Rev Esp Enferm Dig 2021 02;113(2):141-142

Urgencias, Hospital Universitario Virgen de las Nieves, España.

Postgrad Med J 2020 Nov 24. Epub 2020 Nov 24.

Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

Zhonghua Wei Chang Wai Ke Za Zhi 2020 Nov;23(11):1113-1116

Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China.

Pneumatosis cystoides intestinalis (PCI) is a rare disease, which is characterized by the accumulation of gas cysts located in the submucosa or subserosa of the gastrointestinal tract. It can occur in the whole or part of the gastrointestinal tract from the esophagus to the rectum, but clinically the main involved sites are the colon and small intestine. PCI can also appear in other sites such as mesentery, the greater omentum and the hepatogastric ligament. Read More

Dig Liver Dis 2021 03 5;53(3):289-290. Epub 2020 Nov 5.

Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. Electronic address:

Pediatr Infect Dis J 2021 02;40(2):e85-e86

Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.

We report an infant with COVID-19 who presented with bloody stools, lethargy and imaging findings significant for pneumatosis intestinalis. The infant was treated with conservative therapy, including resuscitation, bowel rest and intravenous antibiotics, successfully avoiding surgical intervention. Read More

Medicine (Baltimore) 2020 Oct;99(40):e22461

Department of Surgery.

Pneumoperitoneum has always been considered a surgical emergency as it represents a perforation of the gastrointestinal tract. Although several cases of pneumoperitoneum with pneumatosis intestinalis (PI) have been reported, the characteristics of such cases remain unclear. The current study aimed to clarify the clinical characteristics of pneumoperitoneum cases with PI detected using computed tomography (CT). Read More

Radiol Case Rep 2020 Nov 24;15(11):2459-2463. Epub 2020 Sep 24.

Department of Radiology, Viet Duc University Hospital, 40 Trang Thi Street, Hang Bong Ward, Hoan Kiem District, Hanoi 100000, Vietnam.

Pneumatosis intestinalis (PI) and pneumoperitoneum are commonly recognized as severe signs of gastrointestinal diseases that require emergency surgery. However, these symptoms can also be caused by benign conditions. We describe 4 cases of benign PI and pneumoperitoneum that were detected in different clinical situations (accidental discovery in bilan of aortic dissection (case #1), bilateral pulmonary embolism (case #2), overflow diarrhea due to fecal impaction (case #3), and in follow-up postbiliary digestive anastomosis surgery (case #4), which were addressed with exploratory surgery (case #1) or conservative treatment (the remaining cases), with favorable outcomes. Read More

Abdom Radiol (NY) 2021 03 14;46(3):1249-1255. Epub 2020 Sep 14.

Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.

Purpose: This scoping review evaluated the currently available data related to abdominal imaging in the SARS-CoV-2 infection.

Method: A systematic review of MEDLINE, EMBASE, SCOPUS, and Web of Science was performed from inception to July 15, 2020 using PRISMA-ScR guidelines. The review included case reports and series discussing radiologic manifestations of SARS-CoV-2 infection in abdominal imaging studies. Read More

Int J Surg Case Rep 2020 29;74:222-225. Epub 2020 Aug 29.

Department of Internal Medicine, Hospital IESS Quito Sur, Quito, Ecuador. Electronic address:

Background: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas infiltration into the intestine wall. When gas is seen in the intestinal wall, it is usually a sign of bowel wall infarction and a surgical emergency; therefore, an adequate differentiation of benign and urgent conditions of pneumatosis intestinalis is necessary to prevent misdiagnosis and inadequate therapies.

Case Presentation: We present the case of a 79-year-old male with past medical history of Alzheimer's, cholecystectomy, and umbilical hernia. Read More

J Int Med Res 2020 Aug;48(8):300060520929128

Brandenburg Medical School, Department of General, Visceral and Thoracic Surgery, University Hospital Neuruppin, Neuruppin, Germany.

Postoperative nutrition via a jejunal tube after major abdominal surgery is usually well tolerated. However, some patients develop nonocclusive mesenteric ischemia (NOMI). This morbid complication has a grave prognosis with a mortality rate of 41% to 100%. Read More

J Dermatol 2020 Nov 12;47(11):e412-e413. Epub 2020 Aug 12.

Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan.

Case Rep Transplant 2020 13;2020:5023948. Epub 2020 Jul 13.

Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.

Pneumatosis intestinalis (PI) is a radiologic finding which is characterized by the accumulation of gas within the bowel wall. This radiologic finding is traditionally thought of in the sense of intestinal ischemia. An uncommon cause of this finding is post organ transplantation. Read More

Abdom Radiol (NY) 2020 Jul 31. Epub 2020 Jul 31.

Department of Radiology, Monaldi Hospital, Naples, Italy.

Intestinal pneumatosis (IP) is an infrequent radiological sign defined as pathological gas infiltration into the bowel wall. It may be associated to different underlying clinical conditions-inflammatory bowel diseases, malignancies, chemotherapy, infections, immune deficiency status, trauma, intestinal ischemia, and necrosis-that are often related to emergency state and require a prompt diagnosis. All the imaging techniques, especially abdominal radiography and Computed Tomography, could detect the presence of IP and discern the forms related to emergency conditions. Read More

Rev Port Cir Cardiotorac Vasc 2020 Apr-Jun;27(2):147

Serviço de Cirurgia Geral, Hospital da Senhora da Oliveira, Guimarães, Portugal; Serviço de Angiologia e Cirurgia Vascular, Hospital da Senhora da Oliveira, Guimarães, Portugal.

Computed tomography showing portal and mesenteric venous gas and intestinal pneumatosis, rare radiological signs that, together, favor the diagnosis of mesenteric ischemia (70% of cases). When present, mortality is around 40-90%. Surgical exploration is mandatory with assessment of the extent of intestinal ischemia and appropriate treatment. Read More

BMJ Open 2020 07 20;10(7):e033519. Epub 2020 Jul 20.

Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland

Introduction: Necrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Read More