CT scan of pneumatosis coli

Computed tomography (CT) imaging of the abdomen is from a 55-year-old female who presented with acute abdominal pain and distension. Image A is a scout film of the abdomen and image B is a magnified view of the small bowel from the scout film. The images reveal air within the wall of the dilated loops of small-bowel, characteristic of pneumatosis intestinalis. The paucity of gas in the colon and rectum suggests SBO or severe ileus. Image C is coronal reformat through the abdomen confirming the accumulation of bubbles of air within the wall of the small bowel (white arrow). Image D is an axial image through the affected small bowel loop that shows more extensive accumulation of air within the wall of the thickened small bowel wall. Associated findings include decompressed large bowel (arrowheads), suggesting small bowel obstruction or severe ileus. In the appropriate clinical setting, the findings are highly suggestive of acute ischemia of the small bowel causing a severe ileus and functional obstruction. Less likely but also possible is small bowel obstruction with secondary ischemia.