Intramural gas
Intramural gas (also known as pneumatosis intestinalis) refers to gas within the wall of the bowel and although in some instances may be an incidental finding, it is often seen in the setting of intestinal ischaemia and infarction.
Gas tracks along the wall, either located submucosally or subserosally appearing as either linear (usually submucosal) or rounded cystic collections (usually subserosal) 1. Gas in the bowel wall in the neonatal period, whatever it's shape, is diagnostic of necrotising enterocolitis. In adults it can also present in an asymptomatic form.
Asymptomatic pneumatosis intestinalis may result from a variety of interrelated contributing factors including:
- mucosal integrity
- intraluminal pressure
- bacterial flora
- intraluminal gas
From a clinical perspective it is essential not to confuse the incidental imaging finding of asymptomatic pneumatosis with symptomatic colonic perforation because the treatment is significantly different 2. The asymptomatic form is being seen more frequently as CT-colonography has become a more commonly applied technique.
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