Pneumatosis Coli

Pneumatoris coli is a special form of pneumatosis intestinalis, which is characterized by gas deposits in the wall of the colon. The phenomenon is often accompanied by cyst formation. Treatment depends on the primary cause and can range from antibiotics to therapeutic endoscopy.

Pneumatosis Coli

What is pneumatoris coli?

Intestinal pneumatosis is an intramural accumulation of gas in the digestive tract. In medicine and radiology, this phenomenon is an extremely rare finding that primarily affects the colon. The gas accumulation is in the wall of the colon or other digestive tract and can occur in different layers of the organs. See polyhobbies for Meanings of PT.

The subserous form below the serosa is differentiated from a submucosal form below the mucosa. Pneumatosis intestinalis can also be classified according to the organ affected. In this context, an intramural accumulation of gas in the colon is called pneumatosis coli. In cystoid pneumatosis, the gases are present in the colon wall in the form of cystic inclusions.

The term pneumatosis intestinalis was first used by Lerner and Gazin in 1946. The exact cause of the disease has not yet been finally clarified. Since the disease is an extremely rare disease and there are only a few case reports, research into the causes will probably take some time.


Pneumatosis coli can be primary idiopathic or secondary. The secondary occurrence in the context of another general disease corresponds to the more common variant. One possible cause is infection. For example, an infection caused by the settled bacteria can lead to increased formation of gases.

The formation of gas-containing cysts is conceivable in this context. Mechanical factors are also conceivable. In some secondary cases, pneumatosis coli has also been associated with obstructive pulmonary disease, such as bronchial asthma or chronic obstructive pulmonary emphysema.

Intestinal necrosis due to ischaemia, necrotizing enterocolitis, sepsis and increased intraluminal pressure due to gastric ulcers are currently discussed as causes. In addition, a connection with immunosuppressed patients could be observed. It has been speculated that immunosuppression is associated with reduced integrity of the gut wall, which can result in secondary gas entry.

Symptoms, Ailments & Signs

Pneumatosis coli can manifest itself through a number of different symptoms and symptoms. Typically, the disease is associated with acute and severe diarrhea. The diarrhea occurs at the beginning of the disease and gets worse as it progresses. This is accompanied by stomach pain, flatulence and occasionally bloody excretions.

In individual cases, deficiencies can occur as a result of the high loss of fluids. As the disease progresses, other symptoms arise, especially in the area of ​​the gastrointestinal tract. This significantly reduces the quality of life of those affected. As a result, psychological complaints such as depression or [[anxiety|anxiety] often develop.

Inferiority complexes and reduced self-esteem are also typical. On the physical side, Crohn’s disease can develop from pneumatosis coli. Then chronic gastrointestinal complaints occur, such as flatulence and a bloated stomach, which represent a further health burden for the person concerned.

If the disease is treated early, such a severe course can usually be averted. The symptoms of pneumatosis coli subside after a few days if the underlying condition is carefully cured. In the absence of treatment, chronic symptoms develop, which severely limit the quality of life and life expectancy of the patient.


The clinical picture of patients with pneumatoris coli depends on the individual case and is characterized by the primary cause, especially in the secondary form. For example, pain is just as conceivable as disturbed digestion or intestinal movement. Gas accumulation in the intestinal wall is common to all patients. In most patients, this accumulation takes the form of cysts and usually affects the area of ​​the right colon.

The left or transverse colon is less commonly affected. In the later course, more or less severe complications can occur in the intestine. Obstructions of the colon are in the foreground. Gastrointestinal bleeding is also possible. In extreme cases, perforation of the intestine has been observed.

As such, a puncture or perforation of the tissue that encases the intestine is referred to in medicine. In addition, immunological inflammations of the colon are conceivable as complications.

Diagnosis & course of disease

The most important criterion for a diagnosis of pneumatoris coli are the gases in the intestinal wall or, if applicable, the gas-filled cysts. The doctor demonstrates the accumulation of gas with an abdominal X-ray examination. In the case of cysts, pseudopolyps should be excluded in the differential diagnosis. The distinction can be made by means of a gas analysis.

The cysts usually contain gas in a composition of five to fifteen percent O2, up to ninety percent N2 and between 0.3 and five percent CO2. False positive results can result from flatulence. Computed tomography is the method of choice for reliable differentiation, since it can be used to distinguish between intramural and extramural gas accumulation. Except for the complications mentioned above, the course of pneumatoris coli is considered to be benign.


Those affected primarily suffer from various digestive disorders. These usually have a very negative effect on the quality of life of those affected and can significantly reduce it. Deformations of the intestine can also occur as a result of the disease and significantly reduce the patient’s quality of life.

This leads to inflammation and various complications. Gas can accumulate in the intestinal wall, which can lead to the formation of cysts. If the disease is not treated, life expectancy can be significantly reduced. Ulcers in the stomach can also occur and also have a negative effect on digestion. In many cases, those affected then deliberately eat less food and suffer from underweight or various deficiency symptoms.

In most cases, there are no complications during treatment. The cysts can be easily removed with the help of surgical procedures. Patients are also dependent on taking antibiotics to avoid inflammation. Whether life expectancy will be reduced due to pneumatosis coli cannot be universally predicted.

When should you go to the doctor?

If gastrointestinal complaints and other signs of pneumatosis intestinalis or pneumatosis coli occur, a doctor’s visit is recommended in any case. The doctor can diagnose the rare bowel disease and suggest further measures. Anyone who notices signs of an intestinal obstruction or even an intestinal perforation must call the emergency doctor. The symptoms must be clarified immediately and, if necessary, treated in intensive care. Affected people can turn to their family doctor or gastroenterologist. Other contacts are the internist or a lung specialist.

If the gastrointestinal problems have caused psychological problems, a therapist can also be consulted. People who have recently suffered from a gastrointestinal infection or suffer from intestinal cysts are particularly at risk. Obstructive lung diseases are also associated with pneumatosis coli. Anyone who is one of the risk patients should consult their doctor if the symptoms mentioned occur. Further medical evaluation is required if gastrointestinal symptoms or other symptoms suddenly reappear after recovery, which indicate that the disease has returned or has not been completely cured.

Treatment & Therapy

The therapy of pneumatoris coli in the secondary form depends mainly on the primary disease. A primary pneumatoris coli does not necessarily have to be treated, but can also be monitored under certain circumstances. This is especially true in cases of low gas accumulation that do not cause symptoms. If cystic inclusions are present, the cysts are ideally removed using minimally invasive procedures.

An example of such a procedure is therapeutic endoscopy, which is often used for intestinal interventions such as the removal of polyps . The body shell is spared. Under certain circumstances, treatment with antibiotics may be necessary in addition to removing the cysts and in the case of gas deposits without cysts. This treatment is preferably based on the administration of metronidazole.

Only in extremely serious cases of pneumatoris coli is it necessary to administer oxygen over several days. If complications occur, the doctor treating you should act as quickly as possible to prevent perforation of the intestine. In this context, surgical intervention may be the treatment of choice. Minor bleeding, on the other hand, does not necessarily require surgical intervention and must be discussed by the doctor with regard to the benefits and risks.


So far, no causes for pneumatoris coli are known apart from the connection with certain primary diseases. This limits the preventive measures to the primary causes mentioned in each case. To date, no preventive steps are available for ideopathic pneumatoris coli.


In most cases, those affected with pneumatosis coli have only very few or even very limited follow-up measures available. Since this is a very rare disease, it is usually only recognized by chance. Therefore, the focus of this disease is a quick and above all an early diagnosis, so that there are no complications or other complaints in the affected person in the further course.

Self-healing is usually not possible with pneumatosis coli, so that the affected person is usually always dependent on medical treatment. Most patients require surgery to relieve symptoms. After such a procedure, the person concerned should definitely rest and take care of his body.

Exertion or stressful and physical activities should definitely be avoided. Likewise, only light food should be eaten immediately after the procedure. In general, it cannot be predicted whether pneumatosis coli will reduce the life expectancy of those affected.

You can do that yourself

Since this very rare disease is a form of pneumatosis intestinalis, the same recommendations for self-help in everyday life apply here. First of all, however, it also applies here that there may be another underlying disease that triggered the pneumatosis coli. She should be found and treated.

Because the disease is often associated with lung disease, patients should definitely quit smoking. Exercise and athletic training in the fresh air supports lung function. If bronchial asthma or even pulmonary emphysema is already present, these diseases must be treated according to the guidelines.

In the case of pneumatosis coli, it is important to support the body’s own immune system, because the immune system of the affected patients is often weakened. If the diarrhea is severe, it can be helpful if the person concerned follows an appropriate diet. The fluid loss should also be compensated. Up to three liters of fluid intake per day are necessary. Drinks such as non-carbonated water, mild herbal teas or vegetable broths are recommended. A regulated sleep-wake cycle with sufficient rest hours also supports the immune system. The intake of live intestinal bacteria supports the intestinal flora.