Pneumatosis intestinalis in oncologic patients: when should the radiologist not be afraid?

Pneumatosis intestinalis (PI) is a term used to describe the presence of submucosal and subserosal gas in the gastrointestinal tract. It can occur as a primary disease or, more commonly, secondary to various other causes ranging from benign conditions to fulminant diseases. We present four cases of benign PI in patients being treated for various types of cancer. They had no abdominal symptoms, the physical examination was normal and PI was an isolated incidental CT finding in the absence of other signs of bowel wall distress. A conservative non-surgical approach was advocated and follow-up imaging documented the resolution of PI. The radiologist should recognize this condition in order to help the oncologist to interpret its clinical significance and avoid unnecessary surgical procedures.