- Eric Goldberg, MD
Eric Goldberg, MD
- Associate Professor of Medicine
- University of Maryland School of Medicine
- J Thomas Lamont, MD
J Thomas Lamont, MD
- Editor-in-Chief — Gastroenterology/Hepatology
- Section Editor — Anorectal Disorders and Misc. Lower GI Disease
- Section Editor — Nutrition, Malabsorption, and Misc. Upper GI Disease
- Professor of Medicine
- Harvard Medical School
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. Intramural gas can also affect the stomach, but this condition is referred to as gastric pneumatosis . Since its first description, PI has appeared in the literature under many names, including pneumatosis cystoides intestinalis, intramural gas, pneumatosis coli, pseudolipomatosis, intestinal emphysema, bullous emphysema of the intestine, and lymphopneumatosis [2,3].
The pathogenesis of PI is poorly understood, and is probably multifactorial. In some cases, PI is an incidental finding associated with a benign etiology, whereas in others, it portends a life-threatening intra-abdominal condition. As a result of the wide array of clinical settings in which PI is encountered, its implications are often misinterpreted. This topic will review the epidemiology, pathogenesis, clinical features, evaluation, and management of PI. The clinical features of necrotizing enterocolitis, an important cause of PI in newborns, is discussed in detail separately. (See "Clinical features and diagnosis of necrotizing enterocolitis in newborns".)
The incidence of pneumatosis intestinalis (PI) is difficult to ascertain since most patients are asymptomatic and never come to clinical attention . Adults are typically diagnosed in the fifth to eighth decade. (See "Clinical features and diagnosis of necrotizing enterocolitis in newborns".)
ETIOLOGY AND PATHOGENESIS
Pneumatosis intestinalis (PI) is idiopathic (15 percent) or secondary (85 percent) to a wide variety of gastrointestinal and non-gastrointestinal illnesses (table 1) [4,5]. The majority of cases in infants are secondary to necrotizing enterocolitis. (See "Clinical features and diagnosis of necrotizing enterocolitis in newborns".)
Numerous hypotheses have been proposed to explain the pathogenesis of PI, including mechanical, bacterial, and biochemical causes. Although the theories are distinctly different, they are not necessarily mutually exclusive. It is likely that multiple pathogenic mechanisms are involved in the formation of PI.
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL FEATURES
- Clinical presentation
- Imaging findings
- Endoscopic findings
- History and physical examination
- Abdominal CT scan
- Laboratory studies
- DIFFERENTIAL DIAGNOSIS
- Emergent management
- Non-emergent management
- - Overview
- - Treatment of the underlying etiology
- - Antibiotics
- - Elemental diet
- Endoscopic therapy
- SUMMARY AND RECOMMENDATIONS