title: Pneumatosis intestinalis in patients with severe thermal injury.
abstract: Severe thermal injury is associated with pronounced changes in intestinal physiology, which may cause ischemia, infarction, and pneumatosis intestinalis (PI). PI is a pathologic condition defined as infiltration of gas into the gastrointestinal tract wall. Historically, PI prompted urgent surgery, yet some surgeons "watch and wait" to avoid the risks of a negative laparotomy. The authors reviewed experience with PI at a single burn center. They retrospectively identified burn center intensive care unit patients with radiographic or pathologic evidence of PI. Data included demographics, injury severity score, TBSA burned, operative findings, length of stay, and mortality. From January 2003 through August 2009, 1129 patients were admitted to the authors' burn center intensive care unit. Fifteen had PI. Twelve had radiographic evidence of PI, and 10 had PI associated with intestinal infarction. Nonsurvivors had lower base deficits (P = .02), higher lactate levels (P = .05), and required vasopressor support (P = .02) within 24 hours of developing PI. Massive intestinal infarction (P = .004) and open abdomens (P = .004) were more common among nonsurvivors. PI can be identified by radiologic or pathologic findings. The authors' experience with PI among patients with burn injury revealed a high mortality rate. Because of the association of bowel ischemia with PI, exploratory laparotomy should be strongly considered in patients with burn injury with radiographic evidence of PI.
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-3611, USA.
authors.forename: Todd F M
authors.initials: TF
authors.lastname: Huzar
authors.forename: John
authors.initials: J
authors.lastname: Oh
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: Booker T
authors.initials: BT
authors.lastname: King
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
authors.forename: Christopher E
authors.initials: CE
authors.lastname: White
authors.forename: Edward
authors.initials: E
authors.lastname: Malin
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Lundy
authors.forename: Seung H
authors.initials: SH
authors.lastname: Kim
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
mesh_terms: D000328:Adult; D002053:Burn Units; D002056:Burns / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D042241:Early Diagnosis; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult