Intramural bowel gas

Dr Jeremy Jones et al.

Intramural bowel gas, also known as pneumatosis intestinalis, refers to gas within the wall of the bowel.

There are different terminologies in the medical literature, such as pneumatosis intestinalis, pneumatosis coli, and pneumatosis cystoides intestinalis. Pneumatosis coli is used when only the colic wall is involved, and is generally an incidental finding in asymptomatic patients. Pneumatosis cystoides intestinalis is descriptive for multiple gaseous cysts along the bowel wall.

Intramural gas can be seen in intestinal ischaemia and eventually bowel infarction. This is the most concerning etiology for intramural gas.

Gas in the bowel wall in the neonatal period, whatever its shape, is diagnostic of necrotising enterocolitis.

Asymptomatic pneumatosis intestinalis may result from a variety of interrelated contributing factors including

  • mucosal integrity
  • intraluminal pressure
  • bacterial flora
  • intraluminal gas

Gas tracks along the bowel wall, appearing as either linear (usually submucosal) or rounded cystic collections (usually subserosal) 1.

  • bowel ischaemia and infarction
  • medication-induced
  • autoimmune disease
  • post-endoscopy/operative

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.

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Article Information

rID: 6168
Section: Signs
Tags: refs, rewrite
Synonyms or Alternate Spellings:
  • Pneumatosis intestinalis
  • Gas within the bowel wall

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    Case 1: necrotising enterocolitis
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    CT colonography, ...
    Case 2: virtual endoscopic view showing gas pocket
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    Case 3: in mid jejunum with concurrent portal venous gas
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    Intramural gas
    Case 4
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    Case 5
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    Case 6
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    Case 7: in NEC
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