Pneumatosis Intestinalis in Adult Bilateral Lung Transplant Patients: A Single Institution Experience and Literature Review

Abstract

Pneumatosis intestinalis (PI) is a radiologic finding which is characterized by the accumulation of gas within the bowel wall. This radiologic finding is traditionally thought of in the sense of intestinal ischemia. An uncommon cause of this finding is post organ transplantation. We did an institutional and literature review of this finding to demonstrate its distinct imaging features and benign nature. It was observed to occur in approximately 5.2% of patients post lung transplant (23/442). On imaging, it displays an expansile/bubbly appearance of gas within the bowel wall that is distinct from the traditional findings seen in intestinal ischemia. Clinical review showed that posttransplant patients with PI can be successfully managed conservatively with early enteral nutrition, oxygen, antibiotics, and limited follow-up imaging. With the increasing use of organ transplantation, PI is being diagnosed with increased frequency. It is important to let clinicians know of this entity and its potential outcomes.

Pneumatosis intestinalis after thoracic organ transplantation in children: A case series and review of the literature

“…Less commonly, patients present, like case 2, with sudden acute‐on‐chronic worsening of severe nausea, nonbilious emesis, and retching. PI was identified in the cecum and ascending colon in both patients, a typical location for PI in the solid organ transplant population 1,7,9,10 …”

“…Possible contributing factors to the PI could have been the initial hypoperfusion related to the transplantation, the performance of endoscopy/colonoscopy, or the presence of a gastrojejunal tube immediately post‐transplantation 4 . One other study showed that placement of a gastrojejunostomy tube following transplant might be a risk factor for the development of PI 10 . Therefore, patients following lung transplantation may be at increased risk of endoscopy complications.…”

“…PI can occur any time post thoracic organ transplantation. However, the majority of cases are diagnosed within 1 year of the transplantation 1,3,6,7,9,10 . In a single‐center study investigating PI following thoracic organ transplantation, the diagnosis was made on average 10 months post‐thoracic organ transplantation 6 .…”

“…In a different single‐center pediatric study about gastrointestinal complications following heart transplantation specifically, PI was noted to occur on average 30 days post‐cardiac transplantation (range 21–35 days) 8 . In three adult studies about PI diagnosis following lung transplantation, PI was diagnosed on average 352.8 days (range 5–2495 days), 7 182 days (range 16–590 days), 1 or 168 days (range 5–1477) 10 after transplant. In our patient population, case 1 was diagnosed 15 days post heart transplant, highlighting that PI can occur soon after transplant, not necessarily after the patient has been discharged from the hospital.…”

“…PI following solid organ transplantation is a rare but known complication. The incidence is estimated to be 2–11% 1,6–10 . We reviewed our transplant center's database and electronic medical record system for the patients who had heart, lung or heart‐lung transplantation between January 2014 and February 2022.…”