J Korean Surg Soc.  2011 Jun;80(Suppl 1):S47-S50. 10.4174/jkss.2011.80.Suppl1.S47.

Pneumatosis intestinalis after adult liver transplantation

• Kim JM
• Park Y
• Joh JW
• Kwon CH
• Kim SJ
• Hong SH
• Lee SK

• KMID: 2096650
• DOI: http://doi.org/10.4174/jkss.2011.80.Suppl1.S47

Abstract

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy.

Keyword

Liver transplantation; Pneumatosis intestinalis; Watery diarrhea

MeSH Terms

Adult
Colon
Cytomegalovirus
Diagnosis, Differential
Diarrhea
Fever
Humans
Liver
Liver Transplantation
Mesentery
Mortuary Practice
Peritonitis
Pneumoperitoneum
Stress, Psychological

Figure

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  Fig. 1 Plain film of abdomen shows diffuse linear intramural air (arrows) along cecum to proximal descending colon.

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  Fig. 2 Computed tomography scan of abdomen shows pneumopericardium (arrow) and pneumoperitoneum (arrowhead).

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  Fig. 3 Computed tomography scan of abdomen shows air density in the retroperitoneum (arrow) and mesentery (arrowhead).

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