Pneumatosis Intestinalis and Its Association With Lung Transplant: Alberta Experience

Exp Clin Transplant. 2018 Feb;16(1):75-80. doi: 10.6002/ect.2016.0289. Epub 2017 Oct 31.


Objectives: We evaluated the incidence, clinical presentation, laboratory findings, possible causes, and outcomes associated with pneumatosis intestinalis in the setting of lung transplant.

Materials and methods: A departmental database showed that, between October 2002 and August 2013, our institution performed 373 lung transplants. The database was queried for all patients who had pneumatosis intestinalis and/or pneumoperitoneum after lung transplant at our institution. For this retrospective chart review, information collected included demographics, baseline variables, symptoms, signs, laboratory parameters, radiologic work-up, medications, including immunosuppressants at presentation, progress and time to resolution, length of hospital stay, and postoperative complications, as well as short-term and midterm outcomes (up to 1 year).

Results: The incidence of pneumatosis intestinalis was 2.68% (10/373 patients). Mean age of patients was 52.2 years (range, 34.9-67.9 y). Mean time for development of pneumatosis intestinalis after transplant was 352.8 days (range, 5-2495 d). Abdominal symptoms and signs were present in 6 patients (60%). The large bowel was the site of involvement in all but 1 patient, with predilection for ascending colon (80%) and transverse colon (90%) in most patients. High serum lactate levels were found in 2 patients, and both underwent bowel resection, with surgical specimens revealing evidence of ischemic changes in the gut. Mean dose of prednisone was 22 mg at the time of presentation (range, 0-60 mg). Mean hospital length of stay was 16.9 days (range, 0-40 d). Short-term survival was 100%. Midterm survival at the end of 1 year was 80%. Mean time for pneumatosis to resolve was 18 days (range, 14-35 d).

Conclusions: Pneumatosis intestinalis in bilateral lung transplant recipients can be treated with a minimal amount of imaging, and most patients can be treated conservatively. Survival outcomes are quite good, with 100% during the short term and 80% at 1 year in our series.

MeSH terms

  • Adult
  • Aged
  • Alberta / epidemiology
  • Conservative Treatment
  • Databases, Factual
  • Diagnosis, Differential
  • Female
  • Humans
  • Incidence
  • Length of Stay
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pneumatosis Cystoides Intestinalis / diagnostic imaging
  • Pneumatosis Cystoides Intestinalis / epidemiology*
  • Pneumatosis Cystoides Intestinalis / therapy
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome