Intestinal pneumatosis in adults: diagnostic and prognostic value.
Intestinal pneumatosis (IP) has been traditionally associated with intestinal infarction and poor outcome in adults; recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance, we have retrospectively evaluated 102 patients correlating the CT finding of gastrointestinal parietal gas with clinical data and outcome. Fifty-three patients (52%) had surgical evidence of intestinal infarction. In the remaining patients, a variety of lesions were found including intestinal obstruction, cancer, volvulus, ulcer, hernia, trauma, Crohn's disease, diverticulitis, and iatrogenic causes. We observed the presence of portal vein gas (PVG) associated to IP in 25.5% of cases. In patients having both IP and PVG, intestinal infarction was observed in 69.2% of cases. In our series, overall mortality was 30.4% (31/102), and when PVG was present, it rose to 50% (13/26). In our study, IP has been observed in a broad range of lesions with very different prognosis, the most frequent of which was intestinal infarction. When associated to PVG, there was a much higher prevalence of intestinal infarct, and the prognosis was definitively worse.
Lassandro
Francesco
F
Department of Radiology, Monaldi Hospital, Napoli, Italy.
Mangoni de Santo Stefano
Maria Luisa
ML
Porto
Anna Maria
AM
Grassi
Roberto
R
Scaglione
Mariano
M
Rotondo
Antonio
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
AJR Am J Roentgenol. 2004 Dec;183(6):1667-71
15547208
Clin Radiol. 1992 Dec;46(6):410-1
1493657
Abdom Imaging. 2005 Sep-Oct;30(5):598-600
16096869
AJR Am J Roentgenol. 2001 Dec;177(6):1319-23
11717075
AMA Arch Pathol. 1952 Jun;53(6):523-49
14923068
J Radiol. 2008 Dec;89(12):1907-20
19106848
Abdom Imaging. 1995 Nov-Dec;20(6):523-8
8580746
AJR Am J Roentgenol. 2003 Mar;180(3):733-6
12591685
Emerg Radiol. 2002 Jul;9(2):96-9
15290586
Abdom Imaging. 2006 May-Jun;31(3):277-92
16283583
Arch Surg. 2003 Jan;138(1):68-75
12511155
Radiographics. 1992 Nov;12(6):1069-78
1439012
Ann Surg. 1990 Aug;212(2):160-5
2375647
J Gastrointest Surg. 2007 Oct;11(10):1268-74
17687617
Br J Surg. 1979 Nov;66(11):802-5
519168
AJR Am J Roentgenol. 2007 Jun;188(6):1604-13
17515383
Br J Hosp Med. 1997 May 7-20;57(9):468-9
9274686
J Emerg Med. 1989 Nov-Dec;7(6):645-50
2696753
Radiology. 2003 Mar;226(3):635-50
12601205
Am J Gastroenterol. 1995 Oct;90(10):1747-58
7572888
Radiology. 1998 Apr;207(1):13-9
9530294
AJR Am J Roentgenol. 1995 Dec;165(6):1387-90
7484571