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.

References

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