Pneumatosis Intestinalis of the Colon and Greater Omentum following Small Bowel Resection

INTRODUCTION: Pneumatosis intestinalis (PI) is a condition of gas collection within the bowel wall that can represent either a benign clinical finding or a forerunner to potential gastrointestinal catastrophe. As a potentially sinister discovery typically first detected on radiographic imaging, clinicians need to astutely assess the need for additional urgent medical or surgical management in these patients. Apart from portal venous gas, PI outside of the bowel wall is an extremely rare entity that is poorly described. Hence, it is not necessarily clear if PI outside the bowel wall warrants more aggressive management. Case Presentation. We describe a patient with intermittent abdominal pain who presented with PI of the greater omentum in addition to the right and transverse colon nearly two weeks after small bowel resection. Due to his clinical stability, we elected to closely observe him. His condition completely resolved with conservative management. Discussion. PI in the omentum has not been described in a patient who has survived their underlying pathology. Our patient demonstrated PI radiographically in his right and transverse colon and omentum with complete resolution. We did not have to alter our clinical management because of this unique clinical presentation. CONCLUSION: This case highlights that pneumatosis intestinalis can extend extraluminally and still be managed conservatively with judicious monitoring in the otherwise stable patient.