Management and outcome of pneumatosis intestinalis.
BACKGROUND
Pneumatosis intestinalis (PI), infiltration of gas into the bowel wall, has traditionally been associated with immediate operative intervention and a high mortality rate.


METHODS
We retrospectively reviewed the diagnosis and management of pneumatosis in an attempt to characterize the disease, and examined management strategies.


RESULTS
Ninety-seven patients had a computed tomography (CT) diagnosis of pneumatosis. The location of pneumatosis was as follows: 46% colon, 27% small bowel, 5% stomach, and 7% both small and large bowel. Fourteen patients also had portal venous gas and 6 (43%) of these patients died. Management strategy was non-operative in 52%, operative in 33%, and futile care in 15%. The overall mortality rate was 22% (16% operative, 6% non-operative, and 87% futile). Patients who died had a higher mean APACHE II score (25 vs 11, P <.001).


CONCLUSIONS
Approximately 50% of patients with pneumatosis can be successfully managed non-operatively. The combination of PI and portal venous gas may confer a higher mortality rate.
Morris
Melanie S
MS
Department of Surgery, Oregon Health and Science University, Portland, OR, USA. morrisme@ohsu.edu
Gee
Arvin C
AC
Cho
S David
SD
Limbaugh
Kevin
K
Underwood
Samantha
S
Ham
Bruce
B
Schreiber
Martin A
MA
D018806:APACHE; D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011169:Portal Vein; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome