Background <p>Intestinal pneumatosis, the presence of gas and free air in the extraluminal space of the gastrointestinal tract can still be challenging for clinicians as the severity of underlying illness and adequate therapy might be difficult to assess, especially for complex patients following solid organ transplantations.</p> Objective <p>Purpose of this study was to analyse the occurrence of pneumatosis in patients following heart transplantation at the National Institute of Cardiovascular Diseases in Bratislava, Slovakia<b>.</b></p> Methods <p>We designed this study as a single centre retrospective observational study. Study population included 19 patients who underwent computed tomography scan on which the abdomen was captured from a total of 125 transplanted patients</p> Results <p>Out of 19 patients, intestinal pneumatosis was detected in four patients of which in one it was evaluated only as discrete. Pseudo-pneumatosis was detected in four patients. In the intestinal pneumatosis group, three patients had uneventful course requiring no specific therapy and one patient underwent emergent laparotomy for ileus. Sixteen of the 19 patients who underwent a computed tomography scan had no clinical signs of acute abdomen, although three of them (18.75%) had intestinal pneumatosis. There was no statistical difference between the groups of patients with and without intestinal pneumatosis in terms of preoperative, intraoperative and postoperative characteristics including the hospital course.</p> Conclusion <p>Pneumatosis intestinalis is a relatively common radiological finding in patients post heart transplantation. This radiological sign can accompany variety of clinical conditions from completely benign to life-threatening requiring emergency surgery</p>