Monday, May 30, 2011

Pneumatosis Intestinalis in Bone Marrow Transplant Patients

Pneumatosis intestinalis, gas within the bowel wall, can be seen in patients after bone marrow transplantation. Pneumatosis does not by itself indicate a poor prognosis or require surgery. In the setting of systemic infection or shock, however, pneumatosis is a poor prognostic sign.

The etiology is multifactorial and includes the following:
  • Steroid therapy: Steroids are thought to induce atrophy of Peyer patches, creating mucosal defects that allow dissection of gas into the submucosal or subserosal space.
  • Infection: Due to invasion of the bowel wall by gas-producing bacteria.
  • Acute graft-versus-host disease:
  • Pre-transplantation chemotherapy/radiation therapy: Toxic effect on gastrointestinal mucosa.
  • Septic shock:
  • Small bowel obstruction:
Thanks to Dr. Mark Bankoff for the case and discussion.


Day DL, Ramsay NK, Letourneau JG. Pneumatosis intestinalis after bone marrow transplantation. AJR Am J Roentgenol. 1988 Jul;151(1):85-7.

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