Intestinal pneumatosis in the adult: a radiological sign

Abstract

Intestinal pneumatosis is defined as the presence of air within the bowel wall. This is a radiological sing rather than a clinical condition. Pneumatosis has a long medical story. First described as pneumatosis cystoid in 1730, its detection has been primarily favored by the widespread use of computed tomography over the past decades. It is found more frequently in the small intestine, and rarely in an extraintestinal location. Its estimated prevalence is 0.03% and is most commonly seen among the years of 40 and 50. Pneumatosis intestinalis can be classified into primary and secondary forms. The primary form consists of an idiopathic gas infiltration of the bowel wall that resembles a bunch of grapes, whereas, secondary forms are more frequent and associated to a wide range of pathological patterns such as inflammatory bowel diseases, malignancies, chemotherapy, immune deficiency status or medical maneuvers, but it is a sign mainly related to intestinal ischemia and necrosis, that has long been considered a medical emergency, especially if related to porto-mesenteric vein gas. In the secondary intestinal pneumatosis, the radiological appearances are more varied. It is better detected and evaluated with computed tomography, which is the gold standard technique to detect intestinal pneumatosis and should be used in adults in any case in which either X-rays or ultrasound raise the suspicion. The aim of this article is to determine the usefulness of the intestinal pneumatosis as a radiological sign, with particular attention to the physiopathology, classification and radiological diagnoses.