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Pneumatosis Intestinalis

Jean Khara G. Casillan, RN, MD, Christine Song, DO and Saima Siddiqui, MD, MSCI Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Air in the wall of the small or large intestine

  • Can occur in a variety of clinical settings, ranging from benign to life-threatening

  • Gas can be located in the mucosa, submucosa, and/or...

DIAGNOSIS

HISTORY

  • Symptoms—dependent on location (1)

    • Small intestine

      • Vomiting 60%

      • Abdominal distention 59%

      • Weight loss 55%

      • Abdominal pain 53%

      • Diarrhea 27%

    • Large intestine

      • Diarrhea 56%

      • Hematochezia 50%

      • Abdo...

TREATMENT

GENERAL MEASURES

  • Primary PI can often be managed medically, whereas secondary PI typically requires surgical intervention.

  • A management algorithm for adult PI has been suggested (3)[B] with a ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Serial abdominal exams

  • For asymptomatic patients, follow-up imaging is not required.

  • Repeat imaging for recurrent symptoms.

DIET

  • A trial of an elemental diet for 2 we...

REFERENCES

1
Khalil PN, Huber-Wagner S, Ladurner R, et al. Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res.  2009;14(6):231–239. [View Abs...

ADDITIONAL READING

  • Goyal R, Lee HK, Akerman M, et al. Clinical and imaging features indicative of clinically worrisome pneumatosis: key components to identifying proper medical intervention. Emerg Rad...

CODES

ICD10

K63.89 Other specified diseases of intestine 

ICD9

569.89 Other specified disorders of intestine 

SNOMED

17465007 pneumatosis cystoides intestinalis (disorder) 

CLINICAL PEARLS

  • PI is mostly an incidental, benign finding in adults.

  • It can be difficult to differentiate primary from secondary PI because they can present with similar symptoms.

  • Management of primary...

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