Not all small bowel pneumatosis is ischaemia: a case-based systematic review of non-ischaemic causes.
S Olusola, M Choudhry, V Panem et al.
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Case in brief
A 74-year-old man developed small-bowel pneumatosis after ileostomy reversal. Computed tomography initially raised concern for bowel ischaemia, but he had no clinical or biochemical evidence of sepsis. He was managed conservatively and made a full recovery.
What made this case unusual
The imaging suggested ischaemia in a postoperative patient, yet the clinical and biochemical picture did not support sepsis; conservative management was followed by full recovery.
Diagnostic / clinical pearl
Small-bowel pneumatosis on imaging does not by itself establish ischaemia. Interpret it alongside the patient’s clinical and biochemical status and, where appropriate, serial imaging.
Why it matters
Recognising possible non-ischaemic pneumatosis may help avoid unnecessary laparotomy in carefully selected patients.