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Pneumatosis Intestinalis

Reviewed 06/2018
 


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

Most adult patients are asymptomatic; often found incidentally on clinical imaging 

HISTORY

  • Symptoms—dependent on location (1)

    • Small intestine

      • Vomiting 60%

      • Abdominal distention 59%

      • Weight loss 55%

      • ...

TREATMENT

GENERAL MEASURES

A management algorithm for adult PI has been suggested (3)[B] with a positive predictive value of 100% for surgical pathology. 
  • Critically ill, unstable patients should be res...

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
Jamart J. Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Acta Hepatogastroenterol (Stuttg).  1979;26(5):419–422.  [View Abstract]
2
Olson DE, Kim YW, Ying J, et a...

ADDITIONAL READING

  • Awashima M, Fujikura Y, Kawana A. Pneumatosis intestinalis [published online ahead of print February 9, 2018]. Intern Med. doi:10.2169/internalmedicine.9886-17.

  • Ho LM, Paulson EK, Th...

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—examine for signs of bowel perforation.

  • Abdominal CT scan is diagnostic test of choice in adults.

  • Single best test to identify PI (an...

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