{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:28:28Z","timestamp":1773012508595,"version":"3.50.1"},"reference-count":20,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,5,30]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2018-225068","type":"journal-article","created":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T05:19:50Z","timestamp":1531372790000},"page":"bcr-2018-225068","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Combination therapy for systemic sclerosis-associated pneumatosis intestinalis"],"prefix":"10.1136","volume":"2018","author":[{"given":"Kanyada","family":"Koysombat","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Vittoria","family":"Capanna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Stafford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Orchard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,11]]},"reference":[{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.1","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1038\/nrgastro.2016.99","article-title":"Current management of the gastrointestinal complications of systemic sclerosis","volume":"13","author":"Emmanuel","year":"2016","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.2","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1007\/s10620-018-4977-8","article-title":"Intestinal Involvement in Systemic Sclerosis: A Clinical Review","volume":"63","author":"Sakkas","year":"2018","journal-title":"Dig Dis Sci"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.3","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-007-0018-8"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.4","first-page":"213","article-title":"Aer intestinorum tam sub extima quam in- tima tunica inclusus: observationes anatomicae: comment","volume":"5","author":"Du Vernoy","year":"1730","journal-title":"Acad Acient Imp Petropol"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.5","first-page":"1747","article-title":"Pneumatosis intestinalis: a review","volume":"90","author":"Heng","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.6","doi-asserted-by":"crossref","first-page":"4973","DOI":"10.3748\/wjg.v19.i30.4973","article-title":"A systematic analysis of pneumatosis cystoids intestinalis","volume":"19","author":"Wu","year":"2013","journal-title":"World J Gastroenterol"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.7","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.amsu.2017.09.010","article-title":"A case report and approach to management in pneumatosis intestinalis","volume":"23","author":"Jenkins","year":"2017","journal-title":"Ann Med Surg"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/353245","article-title":"Pneumatosis cystoides intestinalis: a rare benign cause of pneumoperitoneum","volume":"2013","author":"Devgun","year":"2013","journal-title":"Case Rep Radiol"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.9","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.mayocp.2014.01.026","article-title":"Pneumatosis intestinalis with a focus on hyperbaric oxygen therapy","volume":"89","author":"Feuerstein","year":"2014","journal-title":"Mayo Clin Proc"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.10","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.06.1309"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2014.12.007"},{"key":"2025042705303432000_2018.jul10_1.bcr-2018-225068.12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3109\/00365527909179864","article-title":"Pneumatosis cystoides coli associated with high H2 excretion. 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