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Pneumatosis coli is a descriptive sign presenting radiographically as intramural gas limited to the colonic wall.
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There are different terminologies in the medical literature, such as pneumatosis intestinalis, pneumatosis coli, and pneumatosis cystoides intestinalis. Pneumatosis intestinalis is used when only the small bowel wall is involved. Pneumatosis cystoides intestinalis (or coli) is descriptive for multiple gaseous cysts along the bowel wall.
There are 2 types of pneumatosis coli based on morphology 7:
pneumatosis cystoides coli: usually due to benign entities
pneumatosis linearis coli: secondary to ischemic and necrotic bowel
In the pediatric population, it is most frequently seen in premature infants 1. Although symptoms are relatively mild, they are the same as those seen in early (stage I) necrotizing enterocolitis.
In adults, it can have both benign and life-threatening causes.
Benign pneumatosis can be caused by a variety of reasons such as pulmonary disease, systemic disease (scleroderma, lupus, AIDS), intestinal inflammation, iatrogenic/procedures, medications, and organ transplantation 5.
Life-threatening pneumatosis can be caused by intestinal ischemia, obstruction, enteritis/colitis, toxic caustic ingestion, toxic megacolon, organ transplantation, and collagen vascular disease 5.
The following are imaging features of clinically worrisome pneumatosis 6:
soft tissue bowel wall thickening
free intraperitoneal fluid
lesser extent of pneumatosis (more extensive pneumatosis is more commonly benign)
periintestinal soft-tissue stranding
abnormal bowel wall enhancement
atherosclerosis and vascular occlusion
Pneumoperitoneum and pneumoretroperitoneum can be seen with both idiopathic and ischemic pneumatosis 6.
Pseudopneumatosis (mimics) include:
gas trapped between bowel wall and luminal contents
gas trapped by opposing mucosal folds
gas bubbles adherent to the bowel wall
- 1. Crocetti M, Barone MA, Oski FA. Oski's essential pediatrics. Lippincott Williams & Wilkins. (2004) ISBN:0781737702. Read it at Google Books - Find it at Amazon
- 2. Stein E. Anorectal and colon diseases, textbook and color atlas of proctology. Springer Verlag. (2003) ISBN:3540430393. Read it at Google Books - Find it at Amazon
- 3. Pickhardt PJ, Kim DH, Taylor AJ. Asymptomatic pneumatosis at CT colonography: a benign self-limited imaging finding distinct from perforation. AJR Am J Roentgenol. 2008;190 (2): W112-7. doi:10.2214/AJR.07.2843 - Pubmed citation
- 4. Pear BL. Pneumatosis intestinalis: a review. Radiology. 1998;207 (1): 13-9. doi:10.1148/radiology.207.1.9530294 - Pubmed citation
- 5. Olson DE, Kim YW, Ying J, Donnelly LF. CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. (2009) Radiology. 253 (2): 513-9. doi:10.1148/radiol.2532090168 - Pubmed
- 6. Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. (2007) AJR. American journal of roentgenology. 188 (6): 1604-13. doi:10.2214/AJR.06.1309 - Pubmed
- 7. Chang Y, Chang M, Wei S, Wong J. Pneumatosis Cystoides Coli. Gastrointest Endosc. 2006;64(5):820-1. doi:10.1016/j.gie.2006.05.012 - Pubmed