Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome.
OBJECTIVE
The purpose of this study was to analyze the correlation between pneumatosis or portomesenteric venous gas, or both, the severity of mural involvement, and the clinical outcome in patients with small- or large-bowel ischemia.


METHODS
CT scans of 23 consecutive patients presenting with pneumatosis or portomesenteric venous gas caused by bowel ischemia were reviewed. The presence and extent of both CT findings were compared with the clinical outcome in all patients and with the severity and extent of ischemic bowel wall damage as determined by surgery (15 patients), autopsy (three patients), or follow-up (five patients).


RESULTS
Seven patients showed isolated pneumatosis, and 16 patients showed portomesenteric venous gas with or without pneumatosis (11 and five patients, respectively). Pneumatosis and portomesenteric venous gas were associated with transmural bowel infarction in 14 (78%) of 18 patients and 13 (81%) of 16 patients, respectively. Nine patients (56%) with portomesenteric venous gas died. Of seven patients with infarction limited to one bowel segment (jejunum, ileum, or colon), only one patient (14%) died, whereas of the 10 patients with infarction of two or three bowel segments, eight patients (80%) died.


CONCLUSIONS
CT findings of pneumatosis intestinalis and portomesenteric venous gas due to bowel ischemia do not generally allow prediction of transmural bowel infarction, because they may be observed in patients with only partial ischemic bowel wall damage. The clinical outcome of patients with bowel ischemia with these CT findings seems to depend mainly on the severity and extent of their underlying disease.
Wiesner
W
W
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Mortelé
K J
KJ
Glickman
J N
JN
Ji
H
H
Ros
P R
PR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004618:Embolism, Air / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply* / Q000000981:diagnostic imaging*; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008642:Mesenteric Veins; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging*; D011169:Portal Vein; D011379:Prognosis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed