A 68 yo M with a past medical history of HTN, CKD, CAD and Afib presents to the ED with diffuse abdominal pain x 8 hours. He has associated nausea, but no vomiting or diarrhea. On exam, his abdomen is distended, but nontender. A CT scan is obtained. What's the diagnosis? (scroll down for answer)

Answer:  Pneumatosis Intestinalis 

• The presence of air within the wall of the small or large intestines
• Is a radiographic finding, not a diagnosis
• CT is the most sensitive imaging test for identification of PI
• Associated with numerous conditions, from benign to life threatening, including: COPD, connective tissue disorders, autoimmune disease, immunosuppression, infectious enteritis, inflammatory bowel disease, medication related (steroids, chemotherapy) and bowel ischemia/infarction (the most concerning etiology)
• Considered an ominous finding in ischemia, especially in association with portomesenteric venous gas
• If bowel ischemia is suspected and PI is detected on CT, this should prompt immediate surgical consult and patients should be fluid resuscitated and covered with empiric antibiotics to treat bowel flora