Intentional Engagement
1. Findings
colon
fx pneumatosis coli pneumatois intestinalis
fx intramural air
dx ischemic bowel necrotic bowel necrosis infarcted bowel infarction
CTscan
Courtesy Ashley Davidoff MD
CT scan of the abdomen shows intramural gas within the colon wall, consistent with pneumatosis coli. Courtesy of Dr. [Contributor’s Name].
Differential Diagnosis Table (TCV Disease Categories)
Disease TCV Category Reasoning Bowel ischemia Circulatory Most critical cause; pneumatosis indicates compromised blood supply and impending infarction Infectious colitis (e.g., C. difficile) Infectious Severe mucosal inflammation may lead to gas-producing organisms entering the bowel wall Pneumatosis cystoides intestinalis Mechanical / Functional Benign, chronic form often seen in COPD, steroids, or after endoscopy Necrotizing enterocolitis (NEC) (peds) Infectious / Circulatory Pediatric emergency; occurs in neonates due to ischemia + infection synergy Post-endoscopic or surgical intervention Iatrogenic Air introduced via instrumentation; generally benign and self-limited Steroid/immunosuppressive therapy effect Metabolic / Iatrogenic May weaken mucosa or promote gas formation in bowel wall
2. Diagnosis
Dx: Pneumatosis Coli (due to Ischemia)
Definition:
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Presence of gas within the wall of the colon; when caused by bowel ischemia, it indicates transmural infarction or impending necrosis, a life-threatening condition.
Radiologic Features:
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Modality: CT abdomen with IV contrast (preferred)
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Findings:
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Linear or bubbly gas outlining or dissecting through colonic wall
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Often associated with:
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Portal venous gas
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Lack of wall enhancement
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Mesenteric vessel occlusion or narrowing
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Free air or fluid if perforation occurs
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Takeaway Points:
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Pneumatosis on CT is a radiologic sign, not a diagnosis—interpret with clinical context
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If due to ischemia, it is a surgical emergency
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In benign cases (e.g., cystoides), no intervention needed
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Portal venous gas and systemic signs (acidosis, shock) suggest worse prognosis