Potential extraperitoneal space continuous with the peri-intestinal space: CT evidence and anatomical evaluation in patients with pneumatosis intestinalis without intestinal ischemia.
OBJECTIVE
Extraperitoneal spaces, such as the mesenteric space and the retroperitoneal space, can serve as areas that enable a reduction in the pressure exerted by extraperitoneal fluid collection and infiltrating diseases. In clinical practice, understanding the existence of these decompression spaces (or pathways) is very important for making accurate diagnoses. Here, we evaluated potential anatomical extraperitoneal spaces based on the extraluminal gas distribution in patients with pneumatosis intestinalis without intestinal ischemia.


METHODS
The computed tomography scans of ten patients with pneumatosis intestinalis without intestinal ischemia were reviewed, and the anatomic location of the extraluminal gas distribution was investigated.


RESULTS
Four patients were diagnosed as having pneumatosis intestinalis of the small intestine and six were diagnosed as having pneumatosis intestinalis of the large intestine. Mesenteric pneumatosis was observed in nine (90%) of the ten patients. The potential anatomical extraperitoneal spaces (or decompression pathways) were classified as follows: mesenteric (n = 3), retroperitoneal (n = 4), and direct (n = 5).


CONCLUSIONS
The distributions of the extraluminal gas were classified into three categories, and each location may characterize a different decompression pathway. The existence of a potential extraperitoneal space continuous with the peri-intestinal space was confirmed in living subjects.
Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. ktdmrad@tmd.ac.jp
Yoshiaki
Y
Katada
Jun
J
Isogai
Hiroyasu
H
Ina
Mikio
M
Tezuka
Isao
I
Umehara
Hitoshi
H
Shibuya
D034841:Abdominal Cavity / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008643:Mesentery / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging; D011029:Pneumoradiography / Q000379:methods; D012187:Retroperitoneal Space / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*