Correct!
3. Air in the bowel wall

The air in the bowel wall was initially missed because the abdominal film was taken for feeding tube placement. Air in the bowel wall goes by a number of names including pneumatosis, pneumatosis cystoides intestinalis, intramural gas, pneumatosis coli, pseudolipomatosis, intestinal emphysema, bullous emphysema of the intestine, and lymphopneumatosis (2). The differential diagnosis of air in the bowel wall is large but includes Intra-abdominal catastrophes, disorders associated with intestinal mucosal disruption, infections, diseases affecting intestinal motility, immunologic disorders, endoscopic procedures and even pulmonary disorders such as obstructive lung diseases or mechanical ventilation.

CT scans are more sensitive than plain films and may suggest the underlying cause of the air. Our patient’s CT scan clearly shows the air in the bowel wall (Figure 3).

Figure 3. Representative coronal (Panels A-C) and axial (Panels D and E) images from the abdominal CT scans showing air in the bowel wall.

Which of the following should is true regarding air in the bowel wall?

  1. Surgical consultation should be obtained when an intra-abdominal catastrophe is suspected
  2. Observation is appropriate for patients who are asymptomatic
  3. Antibiotics, hyperbaric oxygen, and an elemental diet are appropriate for patients with mild-moderate clinical severity
  4. Palliation may be appropriate for non-surgical candidates with high clinical severity
  5. All of the above

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