title: Management algorithm for pneumatosis intestinalis and portal venous gas: treatment and outcome of 88 consecutive cases.
abstract: BACKGROUND
  Pneumatosis intestinalis (PI) and portal venous gas (PVG) historically mandated laparotomy due to the high mortality rate associated with mesenteric ischemia. Computed tomography (CT) can identify PI/PVG in patients with ischemic emergencies and benign idiopathic conditions.
  
  
  METHODS
  A consecutive series of patients with PI or PVG was reviewed from a single institution over 5 years. Eighty-eight cases of PI/PVG were studied: 74 initial patients (year 1-4) were used to generate a treatment algorithm and fourteen additional cases were used to test the algorithm.
  
  
  RESULTS
  PI and PVG were associated with three major clinical subgroups: mechanical causes (n=29), acute mesenteric ischemia (n=29), and benign idiopathic (n=26); four were unclassifiable. Patients with acute mesenteric ischemia were associated with abdominal pain (p=0.01), elevated lactate (>or=3.0 mg/dL; p=0.006), small bowel PI (p=0.04), and calculated vascular disease score (p<0.0005). The three subgroups could be distinguished using the generated algorithm with a sensitivity of 89%, specificity of 100%, and positive predictive value of 100%.
  
  
  CONCLUSIONS
  With greater sensitivity of modern CT scans, PI and PVG are being detected in patients with a wide range of surgical and non-surgical conditions. This clinical algorithm can identify subgroups to direct surgical intervention for acute ischemic insults and prevent non-therapeutic laparotomies for benign idiopathic PI and PVG.
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY 40202, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Wayne
authors.forename: Matthew
authors.initials: M
authors.lastname: Ough
authors.forename: Andrew
authors.initials: A
authors.lastname: Wu
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
authors.forename: K J
authors.initials: KJ
authors.lastname: Andresen
authors.forename: David
authors.initials: D
authors.lastname: Kuehn
authors.forename: Neal
authors.initials: N
authors.lastname: Wilkinson
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D005740:Gases; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D010535:Laparoscopy; D007813:Laparotomy / Q000379:methods; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005740:Gases