Pneumatosis intestinalis in small bowel obstruction

Description

We present a case of a 42-year-old woman with a history of acute myeloid leukaemia treated with bone marrow transplant. Her case was complicated by graft versus host disease involving the gastrointestinal tract, necessitating partial colectomy with ileostomy. She presented to the hospital with recurrent partial small bowel obstruction (SBO). Abdominal CT scan was consistent with partial SBO, and the patient was admitted for conservative treatment. She was deemed a poor surgical candidate given her multiple comorbidities and immunosuppressed state. Her clinical condition waxed and waned over the next week, and on hospital day 10 the patient developed decreased ileostomy output, increased nausea and vomiting. Abdominal radiographs revealed dilated bowel with increased intramural radiolucency (figure 1), and subsequent CT scan was confirmatory for extensive pneumatosis intestinalis (PI) (figure 2). The patient was treated conservatively with bowel rest and nasogastric suction with favourable outcome.

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