Unveiling gas in the bowel wall: the role of point-of-care ultrasound in diagnosing pneumatosis intestinalis.

backgroundPneumatosis intestinalis (PI) is an infrequent but clinically significant finding that can be a surrogate indicator of underlying severe gastrointestinal conditions, particularly in pediatrics. Despite its typical association with necrotizing enterocolitis (NEC), PI can occasionally present without overt clinical signs, which presents a diagnostic dilemma. CASE PRESENTATION: A 35-day-old preterm infant who presented to the emergency department with loose stools and vomiting. Although the clinical examination was unremarkable, point-of-care ultrasound (POCUS) revealed multiple intramural echogenic foci consistent with PI. Subsequent abdominal X-rays confirmed the diagnosis. The patient was managed conservatively with bowel rest, intravenous fluids, and antibiotics, leading to resolution of symptoms and discharge in stable condition.

conclusionThe case uniquely demonstrates the feasibility and potential diagnostic advantage of POCUS as a diagnostic tool for rapidly identifying PI, especially in the absence of classical clinical signs-highlighting its novel utility in emergency pediatric care.