Conservative treatment and radiological follow-up in a case of pneumatosis intestinalis associated with enteral tube feeding

Pneumatosis Intestinalis (PI) is a rare radiological finding and is defined as the presence of extra- luminal gas within the intestinal wall. PI can be distinguished in a benign form and a life-threatening form, burdened with high mortality. The correct management of PI must always take into account patient's history, his clinical context, laboratory test results and radiological findings, in order to administrate a proper therapy and avoid unnecessary surgical intervention. The pathogenesis of primary PI is still unknown and several theories have been proposed. Here, we report the case of a man with a previous severe traumatic brain injury who developed a transitory PI secondary to the enteral nutrition through a tube feeding, conservatively treated and underwent a radiological follow- up. Our report strengthens the relationship with enteral tube feeding and PI suggesting that any disaccharide used as pharmacological excipient or sweetener in the formulations for enteral tube feeding can potentially promote PI development, especially if administered in large quantities and in particular predisposing conditions. For this reason, the correct management of PI must always take into account patient's history, his clinical context, laboratory test results and radiological findings, in order to achieve a clear comprehension of its aetiology and administrate a proper therapy, avoiding unnecessary and potentially harmful surgery.