Lactulose-Induced Pneumatosis Intestinalis Causing Sudden Deterioration in a Patient With Advanced Hepatic Disease

Herein, we present a case of a 53-year-old male who developed pneumatosis intestinalis (PI) while being treated for hepatic encephalopathy with lactulose. Initially, the patient was administered lactulose, the standard treatment for lowering ammonia levels associated with hepatic encephalopathy; however, this approach unexpectedly resulted in the acute onset of severe PI, which persisted even after lactulose was stopped, further compromising the patient's health. Despite intensive management and the cessation of lactulose, the patient's condition rapidly declined, leading to a transition to palliative care and eventual death. Comparative studies have indicated that both PI and pneumoperitoneum can be triggered by lactulose therapy, with symptoms reversing upon the discontinuation of the medication. This case raises significant concerns regarding the use of lactulose in patients suffering from advanced hepatic disease and multiple comorbidities.