P1627 - Pneumatosis Intestinalis in a Patient With Pneumonia: A Case Report

Juliana Pava-De Los Rios, MD, Jessica Hidalgo, MD, Arbaaz Rao, MD
Rutgers Health/Community Medical Center, Toms River, NJ

Introduction: Pneumatosis intestinalis is a rare entity, that affects about 0.03% of the population (1) and it’s characterized by presence of air-filled cysts in within the walls of the gastrointestinal tract, it can present anywhere in the gastrointestinal tract from the esophagus to the anus (2).

Case Description/Methods: A 77-year-old female is brought to the Emergency Department due to left facial droop and altered mental status that had been present for about 4 days. Code stroke was activated upon the patient´s arrival to the ED. Chest X ray was done on admission, and it reveal an extremely distended stomach with significant amount of content, NG tube was placed in the ED and a CT abdomen and pelvis with contrast was ordered which showed findings concerning for gastric wall pneumatosis and emphysematous gastritis, as well as nonspecific fluid-filled small bowel which can be seen in enteritis and partial small bowel obstruction. Physical exam the abdomen bas distended but non tender. Her WBC was within normal limits, Hemoglobin like previous value and the abdomen was distended but soft. The patient was started on ciprofloxacin and flagyl for antimicrobial treatment. CT abdomen with oral contrast was repeated 36 hours later with findings of decompressed stomach and no evidence of pneumatosis. Mental status significantly improved. The patient was then started on a clear liquid diet which she tolerated. On admission the patient had significant increase in oxygen requirement, she was diagnosed with bilateral pneumonia. Initially patient was on midflow, she was able to wean off to nasal cannula and then to room air. Patient tolerating liquid diet, able to be advance to solid food, no abdominal complaints. She made a full recovery and was discharged home.

Discussion: Pneumatosis intestinalis is a pathology that has a very low incidence that can present in various ways (1) and can be associated with different gastrointestinal pathologies (2) like small bowel obstruction, infections or ischemia, there has been cases which report association of pneumatosis intestinalis with Crohn´s disease (2). Sometimes PI can be related to extraintestinal pathologies, most commonly vascular diseases and respiratory diseases (2).
The case presented was related to a bilateral pneumonia, which has been reported to be one of the most common extraintestinal associations with pneumatosis intestinalis. Patient improved with conservative management and with treatment for the pneumonia she had a full recovery.



Disclosures:


Juliana Pava-De Los Rios, MD, Jessica Hidalgo, MD, Arbaaz Rao, MD. P1627 - Pneumatosis Intestinalis in a Patient With Pneumonia: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.