title: Caecal pneumatosis is not an absolute contraindication for endoluminal stenting in patients with acute malignant large bowel obstruction.
abstract: BACKGROUND
  The computed tomographic (CT) finding of caecal pneumatosis in patients with malignant large bowel obstruction has been associated with ischaemia and impending perforation. Emergency surgery is then usually performed without consideration of endoluminal stenting. The aim of our study was to correlate caecal viability to the CT finding of caecal pneumatosis in patients with acute malignant large bowel obstruction.
  
  
  METHODS
  A retrospective review of the CT scans of all patients presenting with acute malignant large bowel obstruction was performed. Patients with CT evidence of caecal pneumatosis were identified and this was correlated with intraoperative and histopathological findings.
  
  
  RESULTS
  There were 10 patients who had caecal pneumatosis on their CT scans between 2007 and 2010. Five underwent immediate surgery while the other five had emergency endoluminal stenting performed. One failed the stenting procedure and proceeded to emergency surgery. The other four were stented successfully and underwent interval surgery in an elective setting. In the six patients who underwent emergency surgery, four were found to have a viable caecum intra-operatively and underwent a segmental resection. The remaining two had an ischaemic caecum--one had curvilinear pneumatosis and the other had a predominantly bubbly pattern of pneumatosis on their CT scans.
  
  
  CONCLUSIONS
  Caecal pneumatosis alone is not a reliable predictor of caecal viability in patients with acute malignant large bowel obstruction. Such a finding on CT scan should be correlated clinically before excluding the role of endoluminal stenting.
authors: Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore.
authors: James
authors: J
authors: Ngu
authors: Bettina
authors: B
authors: Lieske
authors: Kok Hong Dedrick
authors: KH
authors: Chan
authors: Tian Zhi
authors: TZ
authors: Lim
authors: Wai-Kit
authors: WK
authors: Cheong
authors: Ker-Kan
authors: KK
authors: Tan
mesh_terms: D000328:Adult; D000368:Aged; D002432:Cecum; D003287:Contrast Media; D004630:Emergencies; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011006:Pneumatosis Cystoides Intestinalis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: caecum; colon cancer; intestinal obstruction; pneumatosis; stenting