Three cases of conservatively treated pneumatosis intestinalis associated with jejunal feeding after pancreaticoduodenectomy

Background & aims: Pneumatosis intestinalis (PI), characterised by the presence of intramural air in the bowel wall, is seen in various diseases, in some cases leading to explorative laparotomy and resection of the involved bowel. Here, we describe three cases of PI after pancreaticoduodenectomy (PD) associated with post-operative feeding through a needle catheter jejunostomy (NCJ). Method: Retrospective analysis of three cases of PI after PD with clinical and radiological findings. Results: All patients underwent a PD for periampullary cancer and an NCJ was performed for post-operative feeding. PI was observed 8-32 days after surgery. None of the patients had an acute abdomen or hemodynamical instability necessitating acute surgery. After excluding associated causes of PI, immediate discontinuation of enteral feeding and initiation of parenteral nutrition resulted in a rapid recovery. None of the patients required surgery. Conclusion: In patients with an NCJ for post-operative nutritional support who develop PI, we advise to take these measures as a first step, while excluding associated complications and other causes for PI.

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