Skip to main content

Advertisement

Log in

Pneumatosis Intestinalis in Adults: Management, Surgical Indications, and Risk Factors for Mortality

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Pneumatosis intestinalis (PI) is an unusual finding that can exist in a benign setting but can indicate ischemic bowel and the need for surgical intervention. We present a series of cases of PI in adults to illustrate factors associated with death and surgical intervention.

Methods

We reviewed the radiology database of the Mount Sinai Medical Center for cases of PI between 1996–2006 in adult patients. Chi-square and multivariable logistic regression analyses were used to identify factors significant for surgery and death.

Results

Forty patients developed PI over a 10-year span. The overall in-hospital mortality rate was 20%, and the surgical rate was 35%. Factors independently associated with surgical management on multivariable analysis were age ≥ 60 years (p = 0.03), the presence of emesis (p = 0.01), and a WBC > 12 c/mm3 (p = 0.03). Pre-existing sepsis was independently associated with mortality (p = 0.03) while controlling for surgery.

Conclusion

Patients with the concomitant presence of PI, a WBC > 12 c/mm3, and/or emesis in the >60-year-old age group were most likely to have surgical intervention, whereas PI patients with sepsis had the highest risk for death. A management algorithm is proposed, but further research will be needed to determine which patients with PI may benefit most from surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2

Similar content being viewed by others

References

  1. DuVernoi JG. Anatomische Beobachtungen der Unter der Aussern und Innern Haut der Gedarme Eingeschlossenen Luft. Phys Med Abhandl Acad Wissenschin Petersb 1783;2:182.

    Google Scholar 

  2. Koss LG. Abdominal gas cysts (pneumatosis cystoides intestinorum hominis): an analysis with a report of a case and a critical review of the literature. AMA Arch Pathol 1952;53:523–549.

    PubMed  CAS  Google Scholar 

  3. Pear BL. Pneumatosis intestinalis: A review. Radiology 1998;207:13–19.

    PubMed  CAS  Google Scholar 

  4. St Peter SD, Abbas MA, Kelly KA. The spectrum of pneumatosis intestinalis. Arch Surg 2003;138:68–75.

    Article  PubMed  Google Scholar 

  5. Sequeira W. Pneumatosis cystoides intestinalis in systemic sclerosis and other diseases. Semin Arthritis Rheum 1990;19:269–277.

    Article  PubMed  CAS  Google Scholar 

  6. Patel A, Creery D. Pneumatosis intestinalis in AIDS: an unreported complication. Br J Clin Pract 1990;44:768–770.

    PubMed  CAS  Google Scholar 

  7. Andorsky RI. Pneumatosis cystoides intestinalis after organ transplantation. Am J Gastroenterol 1990;85:189–194.

    PubMed  CAS  Google Scholar 

  8. Boerner RM, Fried DB, Warshauer DM, Isaacs K. Pneumatosis intestinalis. Two case reports and a retrospective review of the literature from 1985 to 1995. Dig Dis Sci 1996;41:2272–2285.

    Article  PubMed  CAS  Google Scholar 

  9. Keyting WS, McCarver RR, Kovarik JL, Daywitt AL. Pneumatosis intestinalis: a new concept. Radiology 1961;76:733–741.

    PubMed  CAS  Google Scholar 

  10. Gillon J, Tadesse K, Logan RF, Holt S, Sircus W. Breath hydrogen in pneumatosis cystoides intestinalis. Gut 1979;20:1008–1011.

    PubMed  CAS  Google Scholar 

  11. Gagliardi G, Thompson IW, Hershman MJ, Forbes A, Hawley PR, Talbot IC. Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature. Int J Colorectal Dis 1996;11:111–118.

    Article  PubMed  CAS  Google Scholar 

  12. Yale CE, Balish E, Wu JP. The bacterial etiology of pneumatosis cystoides intestinalis. Arch Surg 1974;109:89–94.

    PubMed  CAS  Google Scholar 

  13. Read NW, Al-Janabi MN, Cann PA. Is raised breath hydrogen related to the pathogenesis of pneumatosis coli? Gut 1984;25:839–845.

    PubMed  CAS  Google Scholar 

  14. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644–1655.

    PubMed  CAS  Google Scholar 

  15. Hawn MT, Canon CL, Lockhart ME, Gonzalez QH, Shore G, Bondora A, Vickers SM. Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract. Am Surg 2004;70:19–23 (discussion 23–4).

    PubMed  Google Scholar 

  16. Knechtle SJ, Davidoff AM, Rice RP. Pneumatosis intestinalis. Surgical management and clinical outcome. Ann Surg 1990;212:160–165.

    Article  PubMed  CAS  Google Scholar 

  17. Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 2001;177:1319–1323.

    PubMed  CAS  Google Scholar 

  18. Paran H, Epstein T, Gutman M, Shapiro Feinberg M, Zissin R. Mesenteric and portal vein gas: computerized tomography findings and clinical significance. Dig Surg 2003;20:127–132.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Celia M. Divino.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Greenstein, A.J., Nguyen, S.Q., Berlin, A. et al. Pneumatosis Intestinalis in Adults: Management, Surgical Indications, and Risk Factors for Mortality. J Gastrointest Surg 11, 1268–1274 (2007). https://doi.org/10.1007/s11605-007-0241-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0241-9

Keywords

Navigation