PNEUMATOSIS INTESTINALIS: UN DILEMA QUIRÚRGICO

Gerardo Constantino Domínguez Vega

Submitted October 16, 2024

Published 2026-04-06

Artículos de Investigación

Vol. 23 No. 2 (2010): Revista Médico Científica

PNEUMATOSIS INTESTINALIS: A SURGICAL DILEMMA

Gerardo Constantino Domínguez Vega⁺⁻

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Published: 2026-04-06

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Domínguez Vega GC. PNEUMATOSIS INTESTINALIS: A SURGICAL DILEMMA. rmc [Internet]. 2026 Apr. 6 [cited 2026 Oct. 18];23(2):24-32. Available from: https://revistas.up.ac.pa/index.php/revistamedicocientifica/article/view/5965

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Abstract

Pneumatosis intestinalis is an unusual finding that can exist as a benign entity but can indicate a life threatening emergency and the need for surgical intervention. The existing information still confuses the medical community. Considering the wide range of causes and the outcomes of this entity, physicians are frequently faced with a dilemma in identifying those patients who actually require surgery. The understanding of pneumatosis intestinalis with an early recognition and appropriate management is of great importance. This article presents a comprehensive review of scientific literature about the subject, trying to capture in a simple way the existing knowledge about a complex entity.

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References

Bilici A, Karadag B, Doventas A, Seker M. Gastric pneumatosis intestinalis associated with malignancy: an unusual case report. World J Gastroenterol. 2009;15:758-60.
DuVernoi JG. Anatomische Beobachtungen der Unter der Aussern und Innern Haut der Gedarme Eingeschlossenen Luft. Phys Med Abhandl Acad Wissenschin Petersb. 1783;2:182.
Koss LG. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis): an analysis with a report of a case and a critical review of the literature. AMA Arch Pathol. 1952;53:523-49.
Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007;188:1604-13.
Thompson WM, Ho LM. Update on Imaging Features of Adult Pneumatosis Intestinalis. Contemp Diagn Radiol. 2007;30:1-6.
Jamart J. Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Acta Hepatogastroenterol (Stuttg). 1979;26:419-22.
Peloponissios N, Halkic N, Pugnale M, et al. Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases. Arch Surg. 2003;138:1367-70.
Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg. 1978;187:281-87.
Balledux J, McCurry T, Zieger M, Coleman JJ, Sood R. Pneumatosis intestinalis in a burn patient: case report and literature review. J Burn Care Res. 2006;27:399-403.
Brill SE, Skipworth J, Stoker DL. Conservative management of pneumatosis intestinalis and massive pneumoperitoneum in the acute abdomen: a case report. Ann R Coll Surg Engl. 2008;90
.
Braumann C, Menenakos C, Jacobi CA. Pneumatosis intestinalis--a pitfall for surgeons? Scand J Surg. 2005;94:47-50.
Keyting WS, McCarver RR, Kovarik JL, Daywitt AL. Pneumatosis intestinalis: a new concept. Radiology. 1961;76:733–41.
Shimada M, Ina K, Takahashi H, Horiuchi Y, Imada A, Nishio Y, et al. Pneumatosis cystoides intestinalis treated with hyperbaric oxygen therapy: usefulness of an endoscopic ultrasonic catheter probe for diagnosis. Intern Med. 2001;40:896-900.
Forgacs P, Wright PH, Wyatt AP. Treatment of intestinal gas cysts by oxygen breathing. Lancet. 1973;1:579-82.
Gillon J, Tadesse K, Logan RF, Holt S, Sircus W. Breath hydrogen in pneumatosis cystoides intestinalis. Gut. 1979;20:1008–11.
Gagliardi G, Thompson IW, Hershman MJ, Forbes A, Hawley PR, Talbot IC. Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis. 1996;11:111–18.
St Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intestinalis. Arch Surg. 2003;138:68-75.
Maeda Y, Inaba N, Aoyagi M, Kanda E, Shiigai T. Fulminant pneumatosis intestinalis in a patient with diabetes mellitus and minimal change nephrotic syndrome. Intern Med. 2007;46:41-44.
Yale CE, Balish E, Wu JP. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg. 1974;109:89–94.
Read NW, Al-Janabi MN, Cann PA. Is raised breath hydrogen related to the pathogenesis of pneumatosis coli? Gut. 1984;25:839–45.
Påhlman L, Enander LK. Pneumatosis cystoides intestinalis in young patients. Case report. Acta Chir Scand. 1988;154:547-48.
Christl SU, Gibson GR, Murgatroyd PR, Scheppach W, Cummings JH. Impaired hydrogen metabolism in pneumatosis cystoides intestinalis. Gastroenterology. 1993;104:392-97.
Knechtle SJ, Davidoff AM, Rice RP. Pneumatosis intestinalis. Surgical management and clinical outcome. Ann Surg. 1990;212:160-65.
Greenstein AJ, Nguyen SQ, Berlin A, Corona J, Lee J, Wong E, et al. Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality. J Gastrointest Surg. 2007;11:1268-74.
Hawn MT, Canon CL, Lockhart ME, Gonzalez QH, Shore G, Bondora A, et al. Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract. Am Surg. 2004;70:19-23; discussion 23-24.
Connor R, Jones B, Fishman EK, Siegelman SS. Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comput Assist Tomogr. 1984;8:269-75.
Morris MS, Gee AC, Cho SD, Limbaugh K, Underwood S, Ham B, et al. Management and outcome of pneumatosis intestinalis. Am J Surg. 2008;195(5):679–82.
Iannitti DA, Gregg SC, Mayo-Smith WW, Tomolonis RJ, Cioffi WG, Pricolo VE. Portal venous gas detected by computed tomography: is surgery imperative? Dig Surg. 2003;20(4):306-15.
Nelson AL, Millington TM, Sahani D, Chung RT, Bauer C, Hertl M, et al. Hepatic portal venous gas, the ABCs of management. Arch Surg. 2009;144(6):575–81.
Wiesner W, Mortelé KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol. 2001;177(6):1319–23.
Häner C, Inderbitzi R, Badulescu M, Teuscher J. Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis. Schweiz Med Wochenschr. 1998;128:1339-44.
Tsujimoto T, Shioyama E, Moriya K, Kawaratani H, Shirai Y, Toyohara M, et al. Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: a case report and review of the literature. World J Gastroenterol. 2008;14:6087-92.
Caudill JL, Rose BS. The role of computed tomography in the evaluation of pneumatosis intestinalis. J Clin Gastroenterol. 1987;9:223-26.
Masterson JS, Fratkin LB, Osler TR, Trapp WG. Treatment of pneumatosis cystoides intestinalis with hyperbaric oxygen. Ann Surg. 1978;187:245-47.
Grieve DA, Unsworth IP. Pneumatosis cystoides intestinalis: an experience with hyperbaric oxygen treatment. Aust N Z J Surg. 1991;61:423-26.
Wayne E, Ough M, Wu A, Liao J, Andresen KJ, Kuehn D, et al. Management algorithm for pneumatosis intestinalis and portal venous gas: treatment and outcome of 88 consecutive cases. J Gastrointest Surg. 2010;14:437–448.

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[1] Bilici A, Karadag B, Doventas A, Seker M. Gastric pneumatosis intestinalis associated with malignancy: an unusual case report. World J Gastroenterol. 2009;15:758-60.

[2] DuVernoi JG. Anatomische Beobachtungen der Unter der Aussern und Innern Haut der Gedarme Eingeschlossenen Luft. Phys Med Abhandl Acad Wissenschin Petersb. 1783;2:182.

[3] Koss LG. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis): an analysis with a report of a case and a critical review of the literature. AMA Arch Pathol. 1952;53:523-49.

[4] Ho LM, Paulson EK, Thompson WM. Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 2007;188:1604-13.

[5] Thompson WM, Ho LM. Update on Imaging Features of Adult Pneumatosis Intestinalis. Contemp Diagn Radiol. 2007;30:1-6.

[6] Jamart J. Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Acta Hepatogastroenterol (Stuttg). 1979;26:419-22.

[7] Peloponissios N, Halkic N, Pugnale M, et al. Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases. Arch Surg. 2003;138:1367-70.

[8] Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg. 1978;187:281-87.

[9] Balledux J, McCurry T, Zieger M, Coleman JJ, Sood R. Pneumatosis intestinalis in a burn patient: case report and literature review. J Burn Care Res. 2006;27:399-403.

[10] Brill SE, Skipworth J, Stoker DL. Conservative management of pneumatosis intestinalis and massive pneumoperitoneum in the acute abdomen: a case report. Ann R Coll Surg Engl. 2008;90

[11] .

[12] Braumann C, Menenakos C, Jacobi CA. Pneumatosis intestinalis--a pitfall for surgeons? Scand J Surg. 2005;94:47-50.

[13] Keyting WS, McCarver RR, Kovarik JL, Daywitt AL. Pneumatosis intestinalis: a new concept. Radiology. 1961;76:733–41.

[14] Shimada M, Ina K, Takahashi H, Horiuchi Y, Imada A, Nishio Y, et al. Pneumatosis cystoides intestinalis treated with hyperbaric oxygen therapy: usefulness of an endoscopic ultrasonic catheter probe for diagnosis. Intern Med. 2001;40:896-900.

[15] Forgacs P, Wright PH, Wyatt AP. Treatment of intestinal gas cysts by oxygen breathing. Lancet. 1973;1:579-82.

[16] Gillon J, Tadesse K, Logan RF, Holt S, Sircus W. Breath hydrogen in pneumatosis cystoides intestinalis. Gut. 1979;20:1008–11.

[17] Gagliardi G, Thompson IW, Hershman MJ, Forbes A, Hawley PR, Talbot IC. Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis. 1996;11:111–18.

[18] St Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intestinalis. Arch Surg. 2003;138:68-75.

[19] Maeda Y, Inaba N, Aoyagi M, Kanda E, Shiigai T. Fulminant pneumatosis intestinalis in a patient with diabetes mellitus and minimal change nephrotic syndrome. Intern Med. 2007;46:41-44.

[20] Yale CE, Balish E, Wu JP. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg. 1974;109:89–94.

[21] Read NW, Al-Janabi MN, Cann PA. Is raised breath hydrogen related to the pathogenesis of pneumatosis coli? Gut. 1984;25:839–45.

[22] Påhlman L, Enander LK. Pneumatosis cystoides intestinalis in young patients. Case report. Acta Chir Scand. 1988;154:547-48.

[23] Christl SU, Gibson GR, Murgatroyd PR, Scheppach W, Cummings JH. Impaired hydrogen metabolism in pneumatosis cystoides intestinalis. Gastroenterology. 1993;104:392-97.

[24] Knechtle SJ, Davidoff AM, Rice RP. Pneumatosis intestinalis. Surgical management and clinical outcome. Ann Surg. 1990;212:160-65.

[25] Greenstein AJ, Nguyen SQ, Berlin A, Corona J, Lee J, Wong E, et al. Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality. J Gastrointest Surg. 2007;11:1268-74.

[26] Hawn MT, Canon CL, Lockhart ME, Gonzalez QH, Shore G, Bondora A, et al. Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract. Am Surg. 2004;70:19-23; discussion 23-24.

[27] Connor R, Jones B, Fishman EK, Siegelman SS. Pneumatosis intestinalis: role of computed tomography in diagnosis and management. J Comput Assist Tomogr. 1984;8:269-75.

[28] Morris MS, Gee AC, Cho SD, Limbaugh K, Underwood S, Ham B, et al. Management and outcome of pneumatosis intestinalis. Am J Surg. 2008;195(5):679–82.

[29] Iannitti DA, Gregg SC, Mayo-Smith WW, Tomolonis RJ, Cioffi WG, Pricolo VE. Portal venous gas detected by computed tomography: is surgery imperative? Dig Surg. 2003;20(4):306-15.

[30] Nelson AL, Millington TM, Sahani D, Chung RT, Bauer C, Hertl M, et al. Hepatic portal venous gas, the ABCs of management. Arch Surg. 2009;144(6):575–81.

[31] Wiesner W, Mortelé KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. Am J Roentgenol. 2001;177(6):1319–23.

[32] Häner C, Inderbitzi R, Badulescu M, Teuscher J. Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis. Schweiz Med Wochenschr. 1998;128:1339-44.

[33] Tsujimoto T, Shioyama E, Moriya K, Kawaratani H, Shirai Y, Toyohara M, et al. Pneumatosis cystoides intestinalis following alpha-glucosidase inhibitor treatment: a case report and review of the literature. World J Gastroenterol. 2008;14:6087-92.

[34] Caudill JL, Rose BS. The role of computed tomography in the evaluation of pneumatosis intestinalis. J Clin Gastroenterol. 1987;9:223-26.

[35] Masterson JS, Fratkin LB, Osler TR, Trapp WG. Treatment of pneumatosis cystoides intestinalis with hyperbaric oxygen. Ann Surg. 1978;187:245-47.

[36] Grieve DA, Unsworth IP. Pneumatosis cystoides intestinalis: an experience with hyperbaric oxygen treatment. Aust N Z J Surg. 1991;61:423-26.

[37] Wayne E, Ough M, Wu A, Liao J, Andresen KJ, Kuehn D, et al. Management algorithm for pneumatosis intestinalis and portal venous gas: treatment and outcome of 88 consecutive cases. J Gastrointest Surg. 2010;14:437–448.

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