Conservative management of pneumatosis intestinalis.
BACKGROUND
Pneumatosis intestinalis is a rare condition characterized by subserosal and submucosal gas-filled cysts in the gastrointestinal tract; it may be associated with bowel ischemia, perforation, and a high mortality rate. As a result, many authorities advocate an aggressive surgical approach in patients with pneumatosis intestinalis.


METHODS
A 53-year-old female with recurrent, metastatic uterine leiomyosarcoma underwent resection of the pelvic recurrence, low anterior rectal resection with primary anastomosis, and partial hepatectomy for liver metastasis. Her postoperative course was notable for a small bowel obstruction and the finding of pneumatosis intestinalis on radiologic studies. The patient developed mild abdominal pain. She did not develop tenderness or fevers. She was managed with bowel rest, nasogastric tube decompression, total parenteral nutrition, and broad-spectrum antibiotics. The finding of pneumatosis intestinalis resolved over the ensuing 6 days. Her diet was slowly advanced, and she was discharged home in stable condition without further surgical intervention or recurrence of the obstruction or pneumatosis. Currently, her only evidence of disease is pulmonary metastases.


CONCLUSIONS
In select patients, the outcome of a conservative approach to the management of pneumatosis intestinalis is not much different than surgical re-exploration for highly selected patients. The clinical condition of the patient, not solely the finding of pneumatosis intestinalis, should drive management in these cases.
Tchabo
Nana E
NE
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, and Department of Surgery, University of Florida 32611, USA.
Grobmyer
Stephen R
SR
Jarnagin
William R
WR
Chi
Dennis S
DS
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy; D007441:Intubation, Gastrointestinal / Q000379:methods; D007890:Leiomyosarcoma / Q000601:surgery; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011006:Pneumatosis Cystoides Intestinalis / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy; D014594:Uterine Neoplasms / Q000601:surgery
D000900:Anti-Bacterial Agents