Intestinal Pneumatosis

Pneumatosis intestinalis is a very rare disease with gas retention in the digestive organs. Various causes are discussed. This disease is often diagnosed as an incidental finding.

Intestinal Pneumatosis

What is intestinal pneumatosis?

Pneumatosis intestinalis is characterized by gas accumulation in the walls of the digestive tract. The accumulation of gas can occur both below the serosa and below the mucosa. The serosa represents a smooth outgrowth of various organs such as the pericardium, thoracic cavity or peritoneum. See polyhobbies for Meanings of CP.

In the case of intestinal pneumatosis, gas can accumulate in the peritoneal serosa. The mucosa refers to the mucous membranes. In the course of the disease, gas accumulations sometimes form under the mucous membranes. Pneumatosis intestinalis is very rare and usually the result of other underlying diseases. In addition, the disease is divided into different subcategories depending on the involvement of a specific digestive organ.

If the gas accumulation is in the large intestine, the clinical picture is also known as pneumatosis coli. Furthermore, the so-called pneumatosis cystoides intestinalis represents a special form of the disease. The term pneumatosis intestinalis was first used in 1946 by the doctors Lerner and Gazin. The prognosis of the disease always depends on the underlying disease. The course can be harmless and almost symptom-free or life-threatening.


The causes of the disease are varied. The most common trigger is infectious colitis, which is made even more toxic by the administration of medication. Necrotizing enterocolitis can also be a trigger. Furthermore, an undersupply of blood in the context of an intestinal obstruction can also be the cause. Even previous endoscopic examinations are sometimes known to be disease triggers.

Pneumatosis intestinalis itself is therefore often a symptom of both serious and harmless diseases. In addition to bacterial or medicinal triggers, mechanical causes also play a role. In the case of a gastric ulcer, a narrowing of the stomach outlet (pylorus stenosis) or a duodenal stenosis, gas accumulations are often produced in the walls of the digestive organs.

Another complex of causes is the weakening of the immune system. This leads to atrophy of the Peyer’s patches, which results in a loss of integrity of the intestinal wall. A secondary accumulation of gas can form in the intestinal wall. Biochemical, mechanical or bacterial processes are discussed for pathogenesis. Which of the theories is correct cannot yet be answered unequivocally.

Symptoms, Ailments & Signs

The course of the disease is very variable and can even be asymptomatic in many patients. However, the disease is often initiated by acute diarrhea, especially if it is a bacterial pre-existing condition. In some cases, hemorrhagic diarrhea also occurs, mostly caused by Escherichia coli, which produces Shiga toxin.

Krohn ‘s disease or ulcerative colitis can also lead to intestinal pneumatosis. In the case of pneumatosis cyctoides intestinalis, which is considered a special form of pneumatosis intestinalis, only the intestines are affected by these gas accumulations. This disease usually occurs secondary to a serious illness. In 15 percent, however, the disease also occurs primarily without a recognizable cause.

Many diseases of the digestive system or even those outside the digestive system can lead to this gas build-up. However, therapeutic interventions such as endoscopy, chemotherapy or immunosuppressive treatments can also cause pneumatosis cyctoides intestinalis. It is often not clear which symptoms can be assigned to the actual pneumatosis intestinalis or to a specific underlying disease.

Diagnosis & course of disease

Diagnosis of pneumatosis intestinalis is made using imaging techniques. The pronounced gas accumulations can already be detected by X-rays of the abdomen. However, if there is flatulence that has nothing to do with the accumulation of gas in the intestinal walls, a positive false finding can be made.

However, computed tomography makes it possible to clearly differentiate between extramural (outside the walls) and intramural (inside the walls) gas accumulation.


In most cases, complications arise from this disease because it can only be diagnosed incidentally and not at an early stage. Those affected suffer from various complaints in the area of ​​the stomach and intestines, which significantly reduce and restrict the quality of life of those affected. Most patients complain about constant diarrhea, which can also lead to psychological problems and even depression.

Crohn’s disease can also develop and make everyday life difficult for those affected. The accumulation of gas leads to severe flatulence and a bloated stomach. In many cases, those affected feel uncomfortable with the symptoms and also suffer from inferiority complexes or reduced self-esteem. However, the further course of the disease depends heavily on its cause, so that a general prediction is usually not possible.

The treatment itself is carried out either with the help of a surgical procedure or by taking medication. However, this is not always successful. There are no special complications during the treatment itself. In some cases, however, those affected are dependent on a special diet to avoid these symptoms.

When should you go to the doctor?

Pneumatosis intestinalis must always be examined and treated by a doctor. This disease does not heal itself. In most cases, the symptoms worsen and further complications arise if the pneumatosis intestinalis is not treated in time.

A doctor should usually be consulted if the person concerned suffers from diarrhea for a long period of time and without any particular reason. Gas accumulations in the intestines can also occur, which can have a very negative effect on the patient’s quality of life. If these symptoms last longer and are not related to a food intolerance, a doctor must be consulted.

Pneumatosis intestinalis can usually be diagnosed by an internist or by a general practitioner. However, the further treatment method always depends on the exact causes of pneumatosis intestinalis, so that surgical intervention may also be necessary. It cannot be generally predicted whether the disease will lead to a reduced life expectancy. Early diagnosis and treatment always have a positive effect on the further course of the disease.

Treatment & Therapy

The treatment of pneumatosis intestinalis depends on the underlying disease. Often, a primary gas accumulation without a recognizable cause does not need to be treated at all. The disease often runs its course without symptoms. If symptoms are present, they are usually caused by the underlying disease.

However, once the diagnosis of intramural gas accumulation is established, it should be determined whether another condition is causing it and what the condition is. Pneumatosis intestinalis can sometimes even appear as the first symptom of a completely different disease. In addition to toxic infectious, mechanical or other inflammatory causes, a malignancy can also be the cause of intestinal pneumatosis.

It is also important to know exactly which bacteria are present in the event of an infection. In the case of infectious-toxic courses, for example, no conventional [[antibiotics]9 can be used because they really promote the release of the toxins. Inflammatory processes caused by autoimmune reactions against the intestine naturally require a different treatment strategy. Overall, however, the treatment of intestinal pneumatosis is rarely the focus, but rather the underlying disease.


It is not possible to give a concrete recommendation for the prevention of intestinal pneumatosis. Intramural gas accumulation usually represents a sequela of an existing underlying disease, the etiology of which is different in each individual case. In order to reduce the risk of developing a serious health disorder, a healthy lifestyle with a balanced diet, plenty of exercise and little stress is generally recommended.


Since pneumatosis intestinalis is only detected by chance in most cases, the follow-up measures are very limited in most cases. First and foremost, those affected should see a doctor very early and especially when the first signs and symptoms of the disease appear, so that other complications or a further deterioration of the symptoms do not occur. An early diagnosis of pneumatosis intestinalis usually always has a very positive effect on the further course of the disease.

In most cases, the disease itself does not need to be treated, so that no special aftercare measures are necessary. If another disease is responsible for the symptoms of pneumatosis intestinalis, it is usually treated with medication.

Those affected should ensure that they take the medication regularly and take the correct dosage in order to permanently relieve the symptoms. When taking antibiotics, it should be noted that they should not be taken together with alcohol. Regular checks and examinations by a doctor are still necessary in order to properly monitor the current condition of the disease.

You can do that yourself

Since this disease is extremely rare, those affected should be checked for other diseases that may be the cause of intestinal pneumatosis. Only when the underlying disease is known can the pneumatosis intestinalis be treated and a prognosis made.

The immune system of the affected patients is very often weakened. Here the patient can do a lot with a healthy lifestyle to support his recovery. He should eat less fast food and instead eat more fruit and vegetables. A fresh diet rich in minerals and vitamins should be supplemented with plenty of liquid. Water, herbal teas and thin juice spritzers are suitable for this. One and a half to three liters a day are recommended. In addition to a healthy diet, sufficient sleep and avoiding nicotine and alcohol are also part of an effective support of the body’s immune system.

In some cases, a specific diet should also be followed to reduce the symptoms of intestinal pneumatosis, such as flatulence or a bloated abdomen. Those affected can get advice from their doctor, especially if the medication they are given is not working as they should. Draining and detoxifying measures as well as the care of the intestinal culture can also support the recovery. Naturopathic doctors or naturopaths can give recommendations on this.