Pneumatosis Intestinalis (PI) Secondary to Complex Abdominal Wound: A Case Study.

Background: PI is intra-luminal gas within the gastrointestinal tract, penetrating intra-abdominal wound repair procedures often rupture intestinal lumen creating transmural air pockets. If left untreated, PI can proliferate into bowel ischemia, bacteria growth and sepsis along with interrupting healing of intra-abdominal wounds.

Objective: The aim of this case study is to evaluate the correlation between complex abdominal wounds and onset of Pneumatosis Intestinalis (PI).

Method: A 23 year old male patient presented with an abdominal gunshot wound (GSW) and showed poor response to standard surgical interventions for abdominal wound closure. Patient also presented onset of ileus post 3 weeks of inpatient care. A computed tomography (CT) of the abdomen with intravenous (IV) contrast revealed unforeseen presence of PI. CT of the right pericolic gutter indicated walled off fluid and/or gas collection and an intra-abdominal wound exactly posterior to this collection.

Results: Due to poor patient response to previous surgical methods and fragile health state, surgical intervention of PI based on standard of care was rejected. Consequently; due to indication of air emboli secondary to complex abdominal wound, hyperbaric oxygen therapy (HBOT) was employed. Patient was treated with 15 x 90 minute treatments at 100% O2 and 2.5 ATA spanning 3 weeks. Post HBOT treatment, CT revealed complete closure of GSW abdominal wound and eradication of fluid and/or gas collection inducing ileus.

Conclusion: Complex abdominal wounds penetrating to the stomach, small intestine, and duodenum should be meticulously followed for PI manifestations. The majority of PI patients present asymptomatic, proper clinical attention and diagnosis through radiography or endoscopy is rare. Additional research into PI treatment and prevention utilizing HBOT; especially in cases of complex abdominal wounds, is warranted. Optimal ATA level, treatment time, and overall duration of therapy needs to be ascertained in future studies.