Pneumatosis intestinalis

The radiologic finding of gas within the bowel wall, appearing as cystic or linear collections in the mucosal, submucosal, or subserosal layers, and associated with a spectrum of benign to life-threatening gastrointestinal and systemic disorders.

Causes

• Gastrointestinal causes: Increased intraluminal pressure with mucosal disruption

  • Bowel ischemia or infarction

  • Necrotizing enterocolitis

  • Inflammatory bowel disease

  • Bowel obstruction

  • Bowel perforation

  • Mesenteric ischemia

  • Severe colitis

  • Intestinal pseudo-obstruction

• Pulmonary conditions causing alveolar rupture with air dissection into the bowel wall

  • Chronic obstructive pulmonary disease (COPD)

  • Emphysema

• Medications associated with intestinal mucosal injury or altered gas production

  • Chemotherapy

  • Corticosteroids

  • Alpha-glucosidase inhibitors

  • Immunosuppressive therapy (organ transplantation)

• Iatrogenic causes

  • Abdominal surgery: Intestinal anastomosis

  • Endoscopy

  • Colonoscopy

• Infections

  • Clostridioides difficile infection

  • Viral gastroenteritis

  • HIV/AIDS

• Autoimmune and inflammatory causes

  • Systemic sclerosis (scleroderma)

  • Systemic lupus erythematosus (SLE)