Pneumatosis intestinalis (PI) is an uncommon condition characterized by the presence of gas within the bowel wall. We describe 5 cases of PI that occurred after cytotoxic or immunosuppressive treatment for hematological disorders. All patients were neutropenic shortly before or at the time of diagnosis of PI, but did not show specific symptoms. The diagnosis was made by conventional X-ray and confirmed by abdominal computed tomography. Since there were no signs of secondary complications such as peritonitis, ischemia, or perforation, conservative treatment with broad-spectrum antibiotics and parenteral nutrition was initiated. All patients but 1 achieved complete resolution of PI after recovery from myelosuppression. Benign pneumoperitoneum due to PI should be considered in the differential diagnosis of free intra-abdominal air after chemotherapeutic or immunosuppressive therapy. It can be managed successfully by conservative treatment in the absence of secondary complications, if there is recovery of myelopoiesis.

1.
Boerner RM, Fried DB, Warshauer DM, Isaacs K: Pneumatosis intestinalis: Two case reports and a retrospective review of the literature from 1985 to 1995. Dig Dis Sci 1996;41:2272–2285.
[PubMed]
2.
Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA: Pneumatosis intestinalis: A review. Am J Gastroenterol 1995;90:1747–1758.
[PubMed]
3.
Koss LG: Abdominal gas cysts (pneumatosis cystoides intestinorum hominis): An analysis with a report of a case and a critical review of the literature. Arch Pathol 1952;53:523–549.
4.
Sequeira W: Pneumatosis cystoides intestinalis in systemic sclerosis and other diseases. Semin Arthritis Rheum 1990;19:269–277.
[PubMed]
5.
Scheidler J, Stabler A, Kleber G, Neidhardt D: Computed tomography in pneumatosis intestinalis: Differential diagnosis and therapeutic consequences. Abdom Imaging 1995;20:523–528.
[PubMed]
6.
Gagliardi G, Thompson IW, Hershman MJ, Forbes A, Hawley PR, Talbot IC: Pneumatosis coli: A proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis 1996;11:111–118.
[PubMed]
7.
Ellis BW: Symptomatic treatment of primary pneumatosis coli with metronidazole. Br Med J 1980;280:763–764.
8.
Forgacs P, Wright PH, Wyatt AP: Treatment of intestinal gas cysts of oxygen breathing. Lancet 1973;i:579–582.
9.
Knechtle SJ, Davidoff AM, Rice RP: Pneumatosis intestinalis: Surgical management and clinical outcome. Ann Surg 1990;212:160–165.
[PubMed]
10.
de Magalhaes-Silverman M, Simpson J, Ball E: Pneumoperitoneum without peritonitis after allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 1998;21:1153–1154.
[PubMed]
11.
Gelman SF, Brandt LJ: Pneumatosis intestinalis and AIDS: A case report and review of the literature. Am J Gastroenterol 1998;93:646–650.
[PubMed]
12.
Chirletti P, Barillari P, Sammartino P, Cardi M, Caronna R, Arcese W, Petti C, Stipa V: The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. Leuk Lymphoma 1993;9:237–241.
[PubMed]
13.
Villar HV, Warneke JA, Peck MD, Durie B, Bjelland JC, Hunter TB: Role of surgical treatment in the management of complications of the gastrointestinal tract in patients with leukemia. Surg Gynecol Obstet 1987;165:217–222.
[PubMed]
14.
Avigan D, Richardson P, Elias A, Demetri G, Shapiro M, Schnipper L, Wheeler C: Neutropenic enterocolitis as a complication of high dose chemotherapy with stem cell rescue in patients with solid tumors: A case series with a review of the literature. Cancer 1998;83:409–414.
[PubMed]
15.
Hashimoto S, Saitoh H, Wada K, Kobayashi T, Furushima H, Kawai H, Shinbo T, Funakoshi K, Takahashi H, Shibata A: Pneumatosis cystoides intestinalis after chemotherapy for hematological malignancies: Report of 4 cases. Intern Med 1995;34:212–215.
[PubMed]
16.
Kopp AF, Gronewaller E, Laniado M: Pneumatosis cystoides intestinalis with pneumoperitoneum and pneumoretroperitoneum following chemotherapy (see comments). Abdom Imaging 1997;22:395–397.
[PubMed]
17.
Schulenburg A, Herold C, Eisenhuber E, Oberhuber G, Volc-Platzer B, Greinix HT, Reiter E, Keil F, Kalhs P: Pneumocystis cystoides intestinalis with pneumoperitoneum and pneumoretroperitoneum in a patient with extensive chronic graft-versus-host disease. Bone Marrow Transplant 1999;24:331–333.
[PubMed]
You do not currently have access to this content.