A Case of Idiopathic Recurrent Pneumatosis Intestinalis

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Back ground: Pneumatosis intestinalis (PI) is a rare condition that refers to the presence of gas within the wall of the intestine. PI in adults typically presents in the 5th to 8th decade. PI is idiopathic in 15% or secondary to gastrointestinal or non-gastrointestinal causes in 85%. We report a case of recurrent symptomatic PI in a 19 y/o patient in whom no obvious etiology was identified. Case report: A 19 y/o male was admitted due to 2 days h/o back pain radiating to bilateral flanks. He denied alteration of bowel habits or weight loss. He had no signs of intestinal ischemia such as lactic acidosis, leukocytosis or portal venous gas on imaging. CT abdomen revealed pneumatosis in the ileum, splenic and hepatic flexures of the colon. Colonoscopy with biopsy revealed unremarkable colon and terminal ileum. Patient improved clinically with bowel rest and a course of antibiotics. He presented 4 months later with similar episode of back pain without alteration of bowel habits or weight loss. CT abdomen revealed pneumatosis coli in the hepatic flexure. Stool studies and repeat colonoscopy were unrevealing. Patient's symptoms improved with bowel rest. He is doing well at 2 weeks follow up from discharge. Conclusion: PI is an uncommon but important condition which could occur as a primary benign problem in adults or could be related to intestinal ischemia, inflammatory bowel disease (IBD), infections, transplantation, drug therapy such as steroids, chemotherapy or immunosuppression and in the setting of chronic obstructive pulmonary disorder. This case illustrates that recurrent symptomatic pneumatosis could be a benign idiopathic disorder. However it is important to differentiate benign cases from potentially life threatening conditions such as intestinal ischemia which may require immediate surgery. It is also important to exclude IBD and infections by appropriate testing including colonoscopy and stool studies. Symptomatic patients could be treated with antibiotics, elemental diet, inhalational or hyperbaric oxygen. Our patient's symptoms improved with bowel rest and antibiotics.Figure 1Figure 2