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Pneumatosis Intestinalis in Patients with Ischemia: Correlation of CT Findings with Viability of the Bowel

Lily Y. Kernagis1, Marc S. Levine1 and Jill E. Jacobs1,2

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
2 Present address: Department of Radiology, New York University School of Medicine, 560 First Ave., New York, NY 10016.



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  		Fig. 1. —51-year-old man with transmural infarction. Unenhanced CT scan shows marked degree of curvilinear pneumatosis (large straight arrow) in rectum with asymmetric mural thickening (small straight arrow) and perirectal gas (curved arrow) anterior to sacrum. Additional images of upper abdomen from same study (not shown) also revealed small amount of pneumoperitoneum anterior to liver. Patient was presumed to have transmural infarction because he died from complications of ischemic bowel disease without undergoing surgery.

 


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  		Fig. 2A. —81-year-old woman with transmural infarction. Unenhanced CT scan shows dilated small bowel with bubbly pneumatosis (arrows) in several loops of ileum.

 


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  		Fig. 2B. —81-year-old woman with transmural infarction. Unenhanced CT scan of upper abdomen shows portal venous gas (arrow) in liver. Patient was presumed to have transmural infarction because she died from complications of ischemic bowel disease without undergoing surgery. In this study, all four patients with pneumatosis and portomesenteric venous gas had transmural infarction.

 


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  		Fig. 3. —42-year-old woman with partial mural ischemia. Enhanced CT scan shows dilated small bowel with curvilinear pneumatosis (black arrow) in ileum and associated mural thickening (white arrow). At surgery, ileum was found to be ischemic without evidence of transmural infarction; therefore, no bowel was resected. Patient made full recovery.

 


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  		Fig. 4. —59-year-old woman with partial mural ischemia. Unenhanced CT scan shows curvilinear pneumatosis (arrow) in pelvic cecum without other CT findings of ischemia. In this study, both patients with intestinal ischemia and isolated pneumatosis had viable bowel and recovered without surgery.

 

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