Case report
Massive Gas Under Diaphragm After Lung Transplantation: Pneumatosis Intestinalis Simulating Bowel Perforation

https://doi.org/10.1016/j.athoracsur.2014.03.047Get rights and content

The management of pneumatosis intestinalis (PI) can vary from urgent surgical procedure to conservative treatment. Uncommonly, it has been reported in association with organ transplantation, and very few cases have been reported after lung transplantation. The transplant physicians should be well versed in differentiating the fatal form of PI from a benign one. Here, we describe a case of PI with pneumoperitoneum mimicking intestinal perforation after bilateral lung transplantation; this case posed a therapeutic dilemma. After discussion with the multidisciplinary teams, conservative management was chosen to which the patient responded successfully. Clinical signs and imaging features in these situations can mimic true bowel perforation. Hence, a correct diagnosis and proper assessment is imperative.

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Comment

Multiple factors predispose to the development of PI in transplant patients. Steroid therapy, infectious colitis, graft-versus-host disease, and septic shock [6] are some of the important concerns. Steroid therapy increases the risk of PI development significantly. It is thought that steroids cause resolution of Peyer patches in the bowel wall, resulting in mucosal defects through which intraluminal gas dissects into the submucosal or subserosal regions.

Free air in the abdomen probably

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