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Clinical and imaging features indicative of clinically worrisome pneumatosis: key components to identifying proper medical intervention

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Abstract

Purpose

The purpose of this retrospective study was to determine clinical and imaging factors on computed tomography (CT) associated with clinically worrisome pneumatosis intestinalis (PI) that may aid in the decision to provide conservative management or urgent surgical intervention.

Methods

Informed consent was waived in this IRB approved study. Imaging features assessed included the presence, location, and pattern of PI, bowel dilatation, thickening, enhancement, stranding, portal venous (PV) and mesenteric venous gas, mesenteric edema, free air, and ascites. Two radiologists retrospectively evaluated 167 patients with CT reports containing the text “PI” between 1/1/11 and 12/31/13. Clinical data collected included serum lactate, malignancy, bowel disease, operative findings, and death during admission. Clinically, worrisome PI was tabulated by summation of surgical diagnosis of dead bowel and/or death during admission. Chi-square test or Fisher’s exact test was used when appropriate to compare subjects with benign or worrisome PI for categorical variables and the Mann-Whitney test used to compare continuous measures.

Results

Clinically, worrisome PI was present in 44 cases. Benign PI was diagnosed in 97 cases, and these patients were followed conservatively. There was a statistically significant association between clinically worrisome PI and imaging features: location in small bowel (p < 0.0001), bowel dilatation (p = 0.0003), stranding (p = 0.0002), bowel enhancement (p = 0.0384), PV gas (p < 0.0001), mesenteric venous gas (p = 0.0141), and moderate mesenteric edema (p = 0.0036). Location of PI in the small bowel exhibited a statistically significant association with benign PI (p < 0.0002). Statistical significance was found between worrisome PI and the following clinical features: elevated serum lactate (p = 0.0003), underlying bowel disease (p = 0.0004), and mechanical cause of bowel obstruction (p = 0.0497).

Conclusion

CT imaging characteristics and clinical features can help predict clinically worrisome PI and guide crucial management decisions.

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References

  1. Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA (1995) Pneumatosis intestinalis: a review. Am J Gastroenterol 90:1747–1758

    CAS  PubMed  Google Scholar 

  2. Keene JG (1989) Pneumatosis cystoides intestinalis and intramural intestinal gas. J Emerg Med 7:645–650

    Article  CAS  PubMed  Google Scholar 

  3. Galandiuk S, Fazio VW (1986) Pneumatosis cystoides intestinalis: a review of the literature. Dis Colon rectum 29:358–363

  4. Ho LM, Paulson EK, Thompson WM (2007) Pneumatosis intestinalis in the adult: benign to life-threatening causes. Am J Roentgenol 188:1604–1613

    Article  Google Scholar 

  5. Lund EC, Han SY, Holley HC, Berland LL (1988) Intestinal ischemia: comparison of plain radiographic and computed tomographic findings. Radiographics 8:1083–1108

    Article  CAS  PubMed  Google Scholar 

  6. Pear BL (1998) Pneumatosis intestinalis: a review. Radiology 207:13–19

    Article  CAS  PubMed  Google Scholar 

  7. Olson DE, Kim YW, Ying J, Donnelly LF (2009) CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology 253:513–519

    Article  PubMed  Google Scholar 

  8. Blair HA, Baker R, Albazaz R (2015) Pneumatosis intestinalis an increasingly common radiological finding, benign or life-threatening? A case series. BMJ Case Rep. doi:10.1136/bcr-2014-207234

    Google Scholar 

  9. Dawe N, Akhtar S (2010) Pneumatosis intestinalis presenting with a pneumoperitoneum in a patient with chronic bronchiectasis: a delayed diagnosis of superior mesenteric artery ischaemia. BMJ Case Rep. doi:10.1136/bcr.01.2010.2622

    PubMed  PubMed Central  Google Scholar 

  10. Lee KS, Hwang S, Rua SM, Janjigian YY, Gollub MJ (2013) Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. Am J Roentgenol 200:1042–1047

    Article  Google Scholar 

  11. Kurbegov AC, Sondheimer JM (2001) Pneumatosis intestinalis in non-neonatal pediatric patients. Pediatrics 108:402–406

    Article  CAS  PubMed  Google Scholar 

  12. McCarville MB, Whittle SB, Goodin GS et al (2008) Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients. Pediatr Radiol 38:1074–1083

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  Google Scholar 

  14. Hawn MT, Canon CL, Vickers SM et al (2004) Serum lactic acid determines the outcomes of CT diagnosis of pneumatosis of the gastrointestinal tract. Am Surgeon 70:19–24

    PubMed  Google Scholar 

  15. Wiesner W, Mortele KJ, Ros PR et al (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR 177:1319–1323

    Article  CAS  PubMed  Google Scholar 

  16. Gagliardi G, Thompson IW, Talbot IC et al (1996) Pneumatosis coli: a proposed pathogenesis based on study of 25 cases and review of the literature. Int J Color Dis 11:111–118

    Article  CAS  Google Scholar 

  17. Jamart J (1979) Pneumatosis cystoides intestinalis. A statistical study of 919 cases. Acta Hepatogastroenterol (Stuttg) 26(5):419–422

    CAS  Google Scholar 

  18. Morris MS, Gee AC, Cho SD et al (2008) Management and outcome of pneumatosis intestinalis. Am J Surg 195:679–683

    Article  PubMed  Google Scholar 

  19. Pieterse AS, Leong AS, Rowland R (1985) The mucosal changes and pathogenesis of pneumatosis cystoides intestinalis. Hum Pathol 16:683–688

    Article  CAS  PubMed  Google Scholar 

  20. Kernagis LY, Levine MS, Jacobs JE (2003) Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel. Am J Roentgenol 180:733–736

    Article  Google Scholar 

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Authors and Affiliations

  1. Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY, 11549, USA

    Riya Goyal, Hwayoung K. Lee & Leonora W. Mui

  2. Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA

    Meredith Akerman

Authors
  1. Riya Goyal
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  2. Hwayoung K. Lee
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  3. Meredith Akerman
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  4. Leonora W. Mui
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Corresponding author

Correspondence to Riya Goyal.

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Funding

This study did not receive any funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Informed consent was waived for this study.

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Goyal, R., Lee, H.K., Akerman, M. et al. Clinical and imaging features indicative of clinically worrisome pneumatosis: key components to identifying proper medical intervention. Emerg Radiol 24, 341–346 (2017). https://doi.org/10.1007/s10140-017-1484-8

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  • DOI: https://doi.org/10.1007/s10140-017-1484-8

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