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Case of the Month



Pneumatosis Cystoides Intestinalis

The patient is a 62-year-old gentleman who presents to the emergency room with severe abdominal pain. He has a history of bowel obstruction with stoma formation. His past medical history is significant for COPD. Radiographs from a barium enema study demonstrated rounded, lucent filling defects in the right side of the colon. Computed tomography scan showed circumferential large bowel pneumatosis intestinalis (PI).

Pneumatosis intestinalis occurs in two forms. Primary (15% of cases) is a benign idiopathic condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the colon. Usually, this form has no associated symptoms. The second form (85% of cases) is associated with obstructive pulmonary disease as well as with obstructive and necrotic gastrointestinal disease. Numerous hypotheses have been proposed to explain the pathogenesis of PI, including mechanical, bacterial, and biochemical.