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

Background: Pneumatosis 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. Conclusion: The 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.