PNEUMATOSIS-INTESTINALIS - A REVIEW

Pneumatosis intestinalis (PI) is an uncommon but important condition i n which gas is found in a linear or cystic form in the submucosa or su bserosa of the bowel wall, PI is a sign, not a disease; therefore, its relevance should be interpreted within the whole clinical context, PI has been found in several distinctive clinical settings: 1) in premat ure infants with necrotizing enterocolitis; 2) in adults with obstruct ive pulmonary disease; 3) in adults and children with a wide variety o f associated conditions, including pyloric stenosis, jejunoileal bypas s, progressive systemic sclerosis, transplantation, ischemic bowel, an d drug therapy, particularly steroids, chemotherapy, and immunosuppres sion; 4) in adults as a primary benign problem; and 5) as an incidenta l finding in endoscopic mucosal biopsies, The two most important tasks of the physician include: 1) recognition of the entity of PI so that patients are not misdiagnosed and mismanaged as having malignancy or p olyposis; and 2) differentiation of the benign variety, in which no in tervention is indicated, from the life-threatening form, in which imme diate surgery is necessary, Once life-threatening illnesses such as bo wel necrosis, perforation, and infections are excluded, patients sympt omatic from the cysts per se may be treated with oxygen and/or antibio tics, Because the reports of treatment of PI are at best anecdotal, th e decision to treat and the treatment chosen should be carefully balan ced with the risks.