Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality.
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 >or= 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.


CONCLUSIONS
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.
Department of Surgery, The Mount Sinai Medical Center, 5 E. 98th Street, 15th Floor, P.O. Box 1259, New York, NY 12029, USA.
Alexander J
AJ
Greenstein
Scott Q
SQ
Nguyen
Ana
A
Berlin
Jacqueline
J
Corona
Jonathan
J
Lee
Everlyn
E
Wong
Stephanie H
SH
Factor
Celia M
CM
Divino
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011859:Radiography; D012307:Risk Factors