Idiopathic Pneumatosis Intestinalis, Radiological and Endoscopic Images

A 66-year-old female, hypertensive, presented with pain and abdominal distension, constipation, flatulence and “pencil thin stool” that developed over six months, with no other symptoms, namely weight loss. There was no travel history, diet change, sick contacts, abdominal surgery or gastrointestinal diseases. She denied alcohol or tobacco. She was not taking any medication or supplements with the exception of the usual antihypertensive therapy. In the physical examination she was hemodynamically stable with abdominal distention and mild abdominal pain, but without peritoneal reaction. Laboratory evaluation was normal as well as gasometric parameters. Abdominal computed tomography (CT) evidenced the presence of gas in the abdominal wall, at the level of the transverse and rectum-sigmoid colon (Fig. 1), with no other changes. Colonoscopy showed small emphysematous formations in the left colon, emptying with pinprick (Fig. 2) confirming pneumatosis intestinalis (PI). An idiopathic PI was admitted in view of the absence of a secondary cause of PI and endoscopic images of discrete bubbles of gas instead crescentic or linear gas collections more often associated with secondary PI. After low fiber diet, dimethicone, laxatives and two weeks of oral metronidazole the complaints disappeared as well as PI on abdominal CT three months later. PI is a rare clinical entity that can be associated with several diseases including intestinal ischemia and bowel perforation.¹ In 15% of the cases is idiopathic, occurring in a benign context^1,2 and medical therapy can induce remission^3–5 as illustrated here.

Figure 1.

(A and B) The gas in the abdominal wall (arrows) at the level of the transverse colon and rectum-sigmoid colon is clearly visible on the computed tomography (CT). (C and D) CT scan in a lung window demonstrates more easily the presence of gas in the bowel wall.

Figure 2.

Colonoscopy showed multiple small submucosal cysts in the left colon, emptying with pinprick.

Ethical disclosures

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The authors declare that no experiments were performed on humans or animals for this study.

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Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgement

The authors would like to acknowledge Dr. A. Marques (Gastroenterology Department of University Hospital Santa Maria/CHLN) for the important collaboration.