Acute Crit Care.  2019 Feb;34(1):81-85. 10.4266/acc.2016.00311.

Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

• Kim DJ
• Choi YJ
• Yoo YS

• KMID: 2449384
• DOI: http://doi.org/10.4266/acc.2016.00311

Abstract

Pneumatosis intestinalis (PI) is a rare condition of the presence of gas within the bowel walls. PI is associated with numerous underlying diseases, ranging from life-threatening to innocuous conditions. PI is believed to be secondary to coexisting disorders in approximately 85% of all cases. This paper reviews the case of a patient who was diagnosed 7 years prior with pneumoperitoneum from unknown causes without any symptoms. The patient was admitted to the intensive care unit for the management of aspiration pneumonia and developed extensive PI after mechanical ventilation, presenting as small bowel obstruction with mesenteric torsion. Although the exact mechanism and etiology of PI are unclear, this case provides an update on the imaging features of and the clinical conditions associated with PI, as well as the management of this condition.

Keyword

intestinal obstruction; pneumatosis intestinalis; pulmonary emphysema

MeSH Terms

Humans
Intensive Care Units
Intestinal Obstruction
Ischemia*
Pneumonia, Aspiration
Pneumoperitoneum
Pulmonary Emphysema
Respiration, Artificial*

Figure

• 

  Figure 1. (A) Massive free air at both subdiaphragmatic areas. Mildly emphysematous lung on the right. (B) Large amount of free air in the abdominal cavity on computed tomography. Both Figures taken 7 years prior.

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  Figure 2. (A) Septated pneumoperitoneum at the right subphrenic area. Dilatation and pneumatosis intestinalis in the small bowel. (B) Segmental edematous small bowel wall thickening with air bubbles (black arrows), and mesenteric torsion showing a whirling sign (white arrow).

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  Figure 3. (A) Twisted small bowel loops in the right lower quadrant. (B) Reduction of stacked small bowel showing massive pneumatosis intestinalis. (C) The other side of the small bowel mesentery showing large bubbles on the small bowel wall. (D) Resected specimen showing extensive pneumatosis intestinalis.

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  Figure 4. H&E staining of small bowel (×5). Numerous air pockets were observed in the subserosal layer.

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