Clinical significance of pneumatosis intestinalis - correlation of MDCT-findings with treatment and outcome

Eur Radiol. 2017 Jan;27(1):70-79. doi: 10.1007/s00330-016-4348-9. Epub 2016 Apr 22.

Abstract

Objectives: To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome.

Method and materials: Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome.

Results: The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03).

Conclusion: In emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia.

Key points: • In emergency patients, PI may be caused by various disorders. • Intestinal ischemia remains the most common cause of PI in acute situations. • PI associated with decreased mural contrast-enhancement indicates acute intestinal ischemia. • PI associated with PMVG should alert the radiologist to possible underlying ischemia.

Keywords: Intestinal ischemia; Intestines; Multidetector computed-tomography; Pneumatosis intestinalis; Portomesenteric venous gas.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Disease Management*
  • Emergencies*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multidetector Computed Tomography / methods*
  • Pneumatosis Cystoides Intestinalis / diagnosis*
  • Pneumatosis Cystoides Intestinalis / therapy
  • Young Adult