Volume 1, Issue 2 | January 2014
Image | Colon

Pneumatosis Intestinalis: Do Not Excise These “Polyps”!

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Birju Shah, MD1, Kiran Anna, MD2, Prasanna Sengodan, MD1, and Hemangi Kale, MD2

1Department of Medicine, MetroHealth Campus of Case Western Reserve University, Cleveland, OH
2Department of Gastroenterology, MetroHealth Campus of Case Western Reserve University, Cleveland, OH

ACG Case Rep J 2014;1(2):72–73. http://dx.doi.org/10.14309/crj.2014.4. Published: January 10, 2014.

Case Report

A 52-year-old male with a history of recurrent deep venous thrombosis underwent a CT scan of the chest investigating a suspected pulmonary embolism. The scan revealed thickening of the splenic flexure with foci of air adjacent to the colon (Figure 1). The patient reported mild nausea and chronic intermittent hemorrhoidal bleeding without abdominal pain. Physical exam and labwork were unremarkable. Colonoscopy to evaluate this radiographic finding demonstrated a corresponding cluster of cystic submucosal lesions of varying sizes with normal overlying mucosa consistent with pneumatosis intestinalis (Figure 2). The patient was discharged home and is being followed up in the gastroenterology clinic.

Sengodan-Figure-1

Figure 1. A computerized axial tomography scan showing thickening of splenic flexure with foci of air adjacent to the colon.

Sengodan-Figure-2

Figure 2. A colonoscopy demonstrating cluster of cystic submucosal lesions of varying sizes with normal overlying mucosa consistent with pneumatosis intestinalis.

First described in 1783 by Du Vernoi, pneumatosis intestinalis is an uncommon but important condition in which gas is found in a linear or cystic form in the submucosa or subserosa of the bowel wall. Pneumatosis intestinalis is a sign rather than a disease, and is generally seen in the fifth to eighth decade of life.1 Although the exact etiology is not clear, multiple hypotheses have been proposed. The most popular theory posits dissection of gas into the bowel wall from either the intestinal lumen (as seen in necrotizing enterocolitis) or from the lungs via the mediastinum (as seen in patients with chronic obstructive pulmonary disease).2 Although up to 15% of cases may be benign with idiopathic etiology, this sign may be a harbinger of life-threatening pathologies such as bowel ischemia, obstruction, or toxic megacolon. On barium studies and endoscopy, it may appear similar to polyps; therefore, recognition of this condition is very important in order to avoid inadvertent resection that can potentially lead to complications such as frank perforation.3


Disclosures

Author contributions: B. Shah wrote the manuscript and chose the images. K. Anna performed the procedure, assisted with images, and is the author guarantor. P. Sengodan formatted the images and wrote the references. AM Kyprianou supervised the process and made revisions to the manuscript.

Financial disclosure: No financial support was received by any means for this article. None of the authors have any conflict of interest or any relationship with the industry to disclose.

Informed consent was obtained for this case report.

Correspondence: Kiran Anna, MD, MRCP, 2500 MetroHealth Drive, MetroHealth Campus of Case Western Reserve University, Cleveland, OH 44109 (annakiran@yahoo.com).

Received: September 10, 2013; Accepted: October 1, 2013


References

  1. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: Benign to life-threatening causes. Am J Roentgenol. 2007;188(6):1604–13. Article | PubMed
  2. Khalil PN, Huber-Wagner S, Ladurner R, et al. Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis. Eur J Med Res. 2009;14(6):231–9. Article | PubMed
  3. Heng Y, Schuffler MD, Haggit RC, Rohrmann CA. Pneumatosis intestinalis: A review. Am J Gastroenterol. 1995;90(10):1747–58. PubMed

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© 2014 Shah et al. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0.