BMJ Case Reports 2018; doi:10.1136/bcr-2018-225068
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Combination therapy for systemic sclerosis-associated pneumatosis intestinalis

  1. Tim Orchard
  1. Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Kanyada Koysombat, kanyada.koysombat{at}
  • Accepted 30 May 2018
  • Published 11 July 2018


We present a case of a patient with pneumatosis intestinalis and pneumoperitoneum secondary to gastrointestinal systemic sclerosis, who presented following recurrent accident and emergency attendances with abdominal pain. Pneumatosis intestinalis is a rare complication of systemic sclerosis; management approaches focus largely on exclusion of life-threatening surgical pathologies and subsequent symptom control. To date, there are still no established gold-standard treatment strategy and no large-scale trial data to support a specific management strategy. We describe a case of successful medical management with a combination of antimicrobial, elemental diet and high-flow inhalation oxygen therapy, with supporting evidence of CT image confirming resolution. This case therefore contributes to the literature, being the first to report both symptomatic and radiological improvement following combination therapy without the need for surgical intervention.


  • Contributors KK and MVC selected the case and performed literature review. KK wrote the manuscript. NS and TO provided guidance and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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