Innocuous pneumatosis intestinalis of the right colon in renal transplant recipients

Abstract

Three cases of innocuous pneumatosis intestinalis (IPI) of the right colon occurred in a series of 218 renal transplant recipients over a five-year period. Each of the three transplants was in the right iliac fossa. Clinically, these patients had little or no gastrointestinal symptoms and had normal physical examinations of the abdomen. One of the patients had a generalized herpes simplex type 2 (HSV II) infection. Cystic or linear lucencies were present within the bowel wall, associated with varying degrees of localized colonic distention. The condition (IPI) did not warrant surgical intervention or reduction of immunosuppressive therapy. The pneumatosis resolved over a period of several weeks without sequelae or recurrence.

Pneumatosis Intestinalis and Pneumoperitoneum After Bilateral Lung Transplantation in Adults

“…We have no explanation for the differing appearance of these two forms of benign PI. Benign PI has been reported in both adults and children who are immunocompromised, which includes recipients of all types of transplants and patients with HIV [10][11][12][13][14][15][16][17][18][19]. In reviewing these articles, it is difficult to determine whether the extensive linear and cystic PI in our patients has been reported by other authors.…”

Pneumatosis Intestinalis Presenting as Small Bowel Obstruction without Bowel Ischemia after Mechanical Ventilation

“…Conversely, any localized condition causing increased translumenal pressure such as chronic pseudo-obstruction may cause PI [17]. Furthermore, cases associated with immunosuppression and, rarely graft-versus-host disease have been described [18,19]. Despite all these possibilities, a large proportion of patients have benign idiopathic disease [4].…”

“…The diarrhea consisted of six to eight episodes of voluminous, watery, loose, and brown stool without hematochezia or melena. 18 respirations per minute, and oxygen saturation of 99% on ambient air. The patient was a nontoxic female in no acute distress.…”

Pneumatosis Intestinalis With a Focus on Hyperbaric Oxygen Therapy

“…[20][21][22] Associated Disease and Causes There are multiple diseases associated with PI (Table). 3,4,7,9,15,18, The most common causes are related to gastrointestinal diseases, pulmonary diseases, rheumatologic diseases, infectious diseases, medication-related diseases, and traumatic diseases secondary to endoscopic or surgical procedures. 2,4,7,15,72 Laboratory Testing Laboratory abnormalities are usually the result of the underlying disease causing the PI.…”

“…3,8 Secondary PI refers to radiologic findings of linear, microvesicular, or more circumferential appearing intramural gas and is associated with various associated diseases with a range of severity. [8][9][10] PATHOPHYSIOLOGY The 2 main pathophysiologic explanations for PI are based on mechanical vs infectious processes. The mechanical theory suggests that PI results from increased intraluminal pressure that forces air into the bowel wall via mucosal defects.…”