Abstract
Background
Pneumatosis intestinalis (PI) refers to the identification of air within the wall
of the gastrointestinal tract. This finding often marks serious underlying pathology,
which can be potentially surgical in nature. However, this process may also occur
within a benign context, for example, in patients who are chronically immunosuppressed.
The prevalence of benign PI may be greater than previously anticipated, because its
discovery is facilitated by the increasingly widespread use of computed tomography
(CT) scanning.
Objectives
We will illustrate how widespread use of CT scanning after trauma leads to incidental
findings, some of which are difficult to distinguish from acute pathologic findings.
We will also discuss the differential diagnosis for PI and the associated clinical
significance.
Case Report
A female patient with two autoimmune disorders requiring immunosuppression presented
after minor trauma. Her clinical stability and benign examination led us to refrain
from ordering a full radiographic evaluation, including an abdominal CT scan. She
was safely discharged; however, per CT several days later, the incidental finding
was made of PI with free intraperitoneal air. These findings after trauma commonly
prompt an exploratory laparotomy. However, given her persistent stability, we attributed
this to immunosuppression rather than to recent trauma.
Conclusion
The indications for ordering CT scans after minor trauma must be carefully considered,
and incidental findings must be interpreted in the context of the overall clinical
scenario.
Keywords
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Article info
Publication history
Published online: January 18, 2012
Accepted:
September 27,
2011
Received in revised form:
June 1,
2011
Received:
June 23,
2010
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
