CTICasesBenign Pneumatosis Intestinalis and Pneumoperitoneum in a Lung Transplant Recipient
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Imaging findings
Routine chest and upper abdominal radiographs demonstrate abnormal gas within the bowel wall and free air beneath the diaphragm. An abdominal CT scan confirms extensive pneumatosis intestinalis involving the hepatic flexure of the colon and pneumoperitoneum. Despite these findings, the patient remained completely asymptomatic. Diagnostic laparoscopy revealed no evidence of bowel ischemia, necrosis, or perforation.
Key takeaways
Pneumatosis intestinalis and pneumoperitoneum are traditionally considered surgical emergencies; however, they can occur as a benign, asymptomatic phenomenon in solid organ transplant recipients, likely related to immunosuppressive therapy. In an asymptomatic patient, conservative management and close monitoring may be appropriate, although the threshold for surgical exploration is low in immunosuppressed patients who cannot mount a normal inflammatory response.
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