title: Computed tomographic diagnosis of pneumatosis intestinalis: clinical measures predictive of the need for surgical intervention.
abstract: OBJECTIVE
  To determine which clinical, laboratory, and radiographic parameters predict positive operative findings in patients with pneumatosis intestinalis on computed tomography (CT).
  
  
  METHODS
  Retrospective record review.
  
  
  METHODS
  Tertiary care hospital and affiliated community hospital.
  
  
  METHODS
  One hundred fifty consecutive patients diagnosed as having pneumatosis intestinalis on CT.
  
  
  METHODS
  Presence or absence of abdominal pathological findings at laparotomy and mortality rates.
  
  
  RESULTS
  Of the 150 patients studied, 54 (36%) were managed nonoperatively, 72 (48%) were managed operatively, and 24 (16%) were considered unsalvageable and given comfort measures only. Sixty patients (47%) improved with nonoperative management or had negative intraoperative findings. In the nonoperative group, 50 (93%) improved (n = 50) and 3 (5%) crossed over to surgery. One patient (2%) died. In the operative group, 63 patients (87%) had operative findings requiring intervention and 9 (13%) had negative results on exploration. Twenty-one patients (28%) died. Univariate analysis identified numerous predictors of positive intraoperative findings, including history of coronary artery disease, tachycardia, tachypnea, hypotension, peritonitis, abdominal distention, and lactic acidemia. The significant radiographic findings included dilated loops of bowel, portal venous gas, and atherosclerosis on CT. On multivariate analysis, only abdominal distention (odds ratio = 13.19; P = .001), peritonitis (odds ratio = 9.35; P = .007), and lactic acidemia (odds ratio = 2.29; P = .02) were predictive of positive intraoperative findings.
  
  
  CONCLUSIONS
  Many patients with pneumatosis intestinalis on CT can be successfully treated nonoperatively. In determining a management strategy, abnormal physical examination findings were more predictive of the need for surgical intervention than laboratory values or radiographic findings.
authors.affiliation: Department of Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. vincent_duron@brown.edu
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Duron
authors.forename: Sandra
authors.initials: S
authors.lastname: Rutigliano
authors.forename: Jason T
authors.initials: JT
authors.lastname: Machan
authors.forename: Damian E
authors.initials: DE
authors.lastname: Dupuy
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mazzaglia
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed