Published online Nov 16, 2014. doi: 10.4253/wjge.v6.i11.564
Revised: September 23, 2014
Accepted: October 23, 2014
Published online: November 16, 2014
The development of intramural intestinal gas may indicate a serious postoperative complication and therefore any radiological indication of such “pneumatosis intestinalis” (PI) in an unwell patient after surgery should put the clinical team on high-alert. However immediate recourse to relook laparotomy may not be always necessary and, further, in some cases may possibly accelerate the deterioration especially if it proves to be non-therapeutic. Careful and close clinical monitoring, as is described in this clinical report, may allow discriminative identification of those in whom this finding is in fact transient and therefore benign and who therefore can be successfully treated without operative re-intervention. We describe the presenting features and background scenario of PI early after laparoscopic total colectomy for medically refractory, severe ulcerative colitis and detail the critical postoperative decision pivots.
Core tip: The successful outcome of our patients with postoperative pneumatosis intestinalis (PI) indicates that a very individualized, nuanced management plan can allow a succesful course with conservative management. At all times it should be remembered that PI developing postoperatively is a radiographic sign rather than a specific diagnosis. It should be a factor in the decision-analysis related to clinical care and not the sole arbitrator.