Pneumatosis Intestinalis in Patients on Chemotherapy or Molecular Targeted Therapy: Report of 3 Cases

Author(s): Abbeel S, Cuyle PJ, Carton S, Van Cutsem E

Pneumatosis intestinalis (PI) is a radiological term to describe the presence of gas in the bowel wall. It can occur as a primary disease or secondary to various other causes ranging from benign conditions to life-threatening diseases. We present three cases of PI in patients being treated for different types of gastrointestinal cancer. The diagnosis was made incidentally on follow-up CT scanning for two patients, who had only mild gastrointestinal symptoms. For the last patient, it was diagnosed in the setting of fever and clostridium difficile infection. A conservative treatment was advocated and follow-up imaging showed resolution of the PI in two out of three cases. It is important to distinguish between chemotherapy induced PI and other life-threatening causes of PI, which often require urgent surgery. After resolution, risks and possible benefits of restarting of the culprit agent should be outweighed.