Hyperbaric Oxygen Is Effective for Treatment of Pneumatosis Intestinalis Due to Systemic Sclerosis

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Pneumatosis intestinalis (PI) is the presence of gas within the bowel wall. Acute PI is associated with acute illness and bowel necrosis. Chronic PI may be asymptomatic and associated with an underlying medical condition such as infectious diseases and rheumatologic conditions. PI has been described in patients with systemic sclerosis. Bowel rest, antibiotics, and pro-kinetics have been proposed treatments with varying success. Hyperbaric oxygen (HBO) therapy has also been described however research on effectiveness is limited. We present a case of complete resolution of pneumatosis intestinalis after hyperbaric oxygen therapy. A 29 year old female with systemic sclerosis, chronic abdominal pain, and gastroparesis was transferred to our hospital for worsening abdominal pain, nausea, vomiting, and inability to tolerate oral feeding. She had been maintained on total parenteral nutrition. One year before her admission, she was diagnosed with pneumatosis intestinalis localized to the ileum. Her prior treatment included bowel rest and broad-spectrum antibiotics but she did not improve radiographically or clinically. On admission, she was afebrile and mildly tachycardic with heart rate in the 110s. Her leukocyte count and lactate were normal. On physical exam, she had sclerodactyly, calcinosis cutis, and microstomia along with diffuse tenderness to palpation of her abdomen. A radiograph of her abdomen showed marked and diffuse PI (Figure 1). CT showed pneumatosis extending from the jejunum to rectum with evidence of free air in the peritoneum. There was no evidence of bowel necrosis. She received two HBO treatments over the course of two days. After her first treatment, she demonstrated marked clinical improvement. On repeat radiograph, there was complete resolution of her pneumatosis (Figure 2). She received an additional HBO treatment with resolution of her abdominal pain and ability to tolerate oral diet.Figure 1Figure 2In patients with chronic medical conditions and associated PI, symptoms may cause a significant reduction in their quality of life. Hyperbaric oxygen therapy has been used successfully to treat PI. There have been no reported complications from HBO therapy. Health care providers should recognize hyperbaric oxygen therapy as a safe, effective and non-surgical treatment of pneumatosis intestinalis. More studies are needed to determine treatment length to ensure resolution of the bowel wall air and keep patients symptom free.