Esophageal pneumatosis in the setting of small bowel ileus with acute resolution after nasogastric tube decompression

Abstract

Esophageal pneumatosis is a rare condition with diverse potential etiologies including traumatic, mechanical, ischemic, obstructive respiratory, autoimmune, immunodeficient, and infectious causes. Here, we present a case of esophageal pneumatosis in the setting of upper gastrointestinal and small bowel ileus, diagnosed on computed tomography (CT), with acute resolution after nasogastric tube decompression. A patient presented to the emergency department with epigastric discomfort. CT of the abdomen/pelvis demonstrated intramural air in the mid-to-distal esophagus, consistent with esophageal pneumatosis, and diffuse dilatation of the visualized esophagus, stomach, and small bowel, consistent with an ileus. Patient was managed with nasogastric tube decompression and bowel rest. Subsequent esophagram did not demonstrate any evidence of perforation and a repeat CT of the abdomen/pelvis, performed 11 hours after initial diagnostic CT, demonstrated interval resolution of patient's esophageal pneumatosis, and improvement of patient's ileus.

Oesophageal pneumatosis: computed tomographic characteristics in three dogs (2018–2021)

“…Increased intraluminal pressure could lead the gas to enter the oesophageal wall through small defects in the mucosa, reaching the submucosa or even the muscular layer. Documented cases describe this process during endoscopy or secondary to an obstruction of the alimentary tract (Huang et al., 2015 ; Katz et al., 1972 ; Tewari et al., 2017 ). Dissection of gas from an extra‐oesophageal source can occur in case of pneumomediastinum (Neal & Jha, 2020 ).…”

“…Benign conditions include immune‐mediated, infectious, pulmonary, gastrointestinal, iatrogenic and idiopathic diseases. It has been described also with life‐threatening conditions such as traumatic, mechanical and ischemic processes (Aste et al., 2005; Bakkali et al., 2014; Chelimilla & Makker, 2013; Fisk & Allen‐Durrance, 2019; Grassi et al., 1995; Ho et al., 2007, Fischetti et al., 2004; Keklik et al., 2016; Lang et al., 2011; Lefor, 2008; Mitsuyoshi et al., 2015; Tewari et al., 2017; Tixedor et al., 1998; Torres et al., 2018). These two groups of conditions have different clinical management and prognosis, but they can have similar imaging findings.…”