A 91-year-old woman presented to the accident and emergency department with acute abdominal pain and distension with raised white cell count of 13.98 x 109/litre (normal range 4-11 109/litre) and serum lactate of 15 mmol/litre (normal range 0.5-1 mmol/litre).

Computed tomography of her abdomen with contrast showed gas within the wall of the distal ileum due to small bowel ischaemia. 

 

Fig. 1: Computed tomography coronal contrast enhanced images of abdomen showing dilated small bowel loops with gas attenuation noted in bowel wall in keeping with pneumatosis intestinalis.

 

The patient was not considered suitable for surgical intervention and was placed on end of life care pathway for comfort care.

Pneumatosis intestinalis is a sign, not a disease and was first described by Du Vernoi in 1730.Pneumatosis intestinalis can be associated with serious abdominal conditions including pyloric stenosis, bowel ischaemia and infarction and volvulus.2

Therefore, it is to remind the clinicians the importance of this radiological sign to correctly and promptly identify the underlying aetiology of pneumatosis intestinalis so that appropriate management can be undertaken.

 


Dr Amr M. Elyasaky, Specialty Registrar

Dr Sahar Fatima, Senior House Officer General Medicine

Dr Amarah Kiani,Consultant Radiologist

Dr Muhammad JH Rahmani, Consultant Physician

m.rahmani3@nhs.net


References

  1. Vernoi D. Anatomische Beobachtungen der unter der aeussern und inner Hautn der Gedaerme eingeschlossenen. Luft Phys Med Abhandl Acad Wissensch Petersb, 1783; 2, 182. Retrieved from https://ci.nii.ac.jp/naid/10014974747/
  2. Pear B. L. Pneumatosis intestinalis: a review. Radiology 1998: 207(1), 13–19. https://doi.org/10.1148/radiology.207.1.9530294