Benign Pneumatosis Intestinalis in a Patient With Symptomatic COVID-19

The pathophysiology of pneumatosis intestinalis (PI) is poorly understood. PI can be associated with COVID-19 infection. Although this relationship is unclear, proposed mechanisms include direct viral invasion of the mucosa, the use of IL-6 inhibitors, and bowel ischemia. We present a case of a 75-year-old female with benign PI after symptomatic COVID-19 following recovery from a recent abdominal operation. The patient presented with obstructive symptoms, dyspnea, and tachycardia. Workup revealed PI with leukocytosis and lactic acidosis. She was taken emergently to the operating room for exploration, which revealed a short segment of otherwise healthy jejunum with PI. She recovered well and was discharged back to a facility. This case differs by the benign nature of PI and the possible direct effect of COVID-19 on the small bowel. Benign PI in the setting of COVID-19 infection may be secondary to the disease process itself rather than its treatment modality or hypercoagulability. This potential association needs to be considered when evaluating the patient with incidental PI on imaging. Patients with chronic constipation and underlying lung disease may be at a higher risk of developing PI, with varying clinical significance.