Pneumatosis Intestinalis and Inferior Vena Caval Gas in a Patient with Neutropenic Enterocolitis

Pneumatosis Intestinalis and Inferior Vena Caval Gas in a Patient with Neutropenic Enterocolitis

Neutropenic enterocolitis (NE), the most serious gastrointestinal complication, has been reported as a clinical syndrome that occurs in the setting of disease- or chemotherapy-induced neutropenia. Complications of NE include bowel necrosis with perforation, fistula, stenosis, massive bleeding, abscess formation, and pneumatosis intestinalis (PI). Most physicians recommend initial conservative management with bowel rest, intravenous fluids, total parenteral nutrition, broad-spectrum antibiotics, and normalization of neutrophil counts. Surgical intervention is recommended in the event of obstruction, perforation, persistent gastrointestinal bleeding despite correction of thrombocytopenia and coagulopathy, or clinical deterioration. We experienced a patient whose abdominal computed tomography scan showed pneumoretroperitoneum, intramural gas in the colon, and inferior vena caval gas. Her condition improved after treatment with granulocyte colony-stimulating factor and broad-spectrum antibiotics. We report on this case along with a review of the literature.