Presentation
Acute abdominal pain in a patient with stage IV microcytic lung cancer and hepatic metastases. Carboplatin, etoposide and atezolizumab were initiated one week prior to presentation.
Patient Data
Extensive intramural gas (subserous and submucosal gas cysts) involving the cecum, ascending and proximal transverse colon, with moderate amount of gas in the mesenteric and pericolic fat. There are also small air bubbles within the right perinephric space and inside adjacent small bowel loops. Normal patent mesenteric vessels. Normal intestinal mucosal enhancement. Multiple hypoattenuating liver metastases.
Case Discussion
Intestinal pneumatosis is a radiological term that defines the presence of gas within the intestinal wall 1. On CT, pneumatosis intestinalis appears as a bubbly pattern of air along the intestinal wall.
Many cytotoxic chemotherapeutic agents have been reported to be associated with pneumatosis intestinalis 2.
In our case, the patient had a history of recent chemotherapy and his white blood cell count on admission was below 500/μL. Emergency laparotomy showed no evidence of intestinal perforation or necrosis. The patient was treated conservatively and clinically improved after changing the chemotherapy regimen.