title: The significance of pneumatosis intestinalis or bowel perforation in patients with gynecologic malignancies.
abstract: OBJECTIVE
  The objectives of this study were to evaluate the clinical significance and outcome of pneumatosis intestinalis or bowel perforation in patients with gynecologic malignancies.
  
  
  METHODS
  A retrospective review of all gynecologic oncology patients at our institution from 1996 to the present was performed to identify computed tomography examinations showing pneumatosis, free air, or the presence of portal venous gas. Admission symptoms, laboratory testing, radiographic and operative findings, and overall survival were evaluated. At the discretion of the attending gynecologic oncologist, patients were managed either surgically or conservatively. Statistical analysis was performed with Fisher's exact test.
  
  
  RESULTS
  Twenty-eight patients met study criteria. Thirteen patients were excluded as a result of radiographic free air immediately following surgery, thus leaving 15 patients for analysis. Sixty percent (n = 9) of patients were managed surgically while 40% (n = 6) were managed conservatively. Pain and tenderness at presentation prompted surgical intervention in a statistically significant number of patients (P = 0.04). No other sign or symptom was significant. Of the 6 patients managed conservatively, 3 (50%) died within 1 week of diagnosis. Survival for the others was 2, 4, and 6 months. Of the 9 patients managed surgically 6 (67%) patients died, 4 within 2 weeks of surgery and the remainder at 2 and 12 months postoperatively. The 3 patients who survived all had surgical intervention and none had radiographic or pathologic evidence of cancer at the time of presentation (P = 0.01). Overall mortality at 6 months was 73% (11/15). Surgical management was associated with prolonged ICU care, mechanical ventilation, and sepsis.
  
  
  CONCLUSIONS
  Pneumatosis intestinalis and bowel perforation carry a grave prognosis for patients with gynecologic malignancies. These data suggest that patients explored for radiographic evidence of pneumatosis or perforation with preoperative evidence of active malignancy do not survive the immediate postoperative period. The balance between quality and quantity of life must be considered when weighing the options for the management of this condition.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. horowitzn@msnotes.wustl.edu
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Janet S
authors.initials: JS
authors.lastname: Rader
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhalla
authors.forename: Randall K
authors.initials: RK
authors.lastname: Gibb
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome