Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

Abstract

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

Pneumoperitoneum and Pneumatosis cystoides intestinalis, a dangerous mixture. A case report

“…Nonetheless, CT has a clear advantage since the gas can be seen in the cysts and in the portal venous system or as pneumoperitoneum; thus, it can be of great assistance in revealing possible complications [ 1 , 8 ]. About 3% of the patients with PCI can present with pneumoperitoneum, volvulus, intestinal obstruction, or ischemia, which may alter the usual therapy course [ 9 ]. Pathology of usually reveal giant cell arrays and partial or collapsed cysts.…”

Pneumatosis intestinalis with pneumoperitoneum: Not always a surgical emergency

“…When combined with pneumoperitoneum, PI usually indicates a surgical emergency [2 , 3] . However, some nonemergency causes that can lead to PI have been described, such as respiratory diseases, systemic diseases, immunodeficiency, after organ transplants, and iatrogenesis [4] , [5] , [6] .…”

“…Clinically, benign PI is often an asymptomatic, incidental finding during endoscopy or imaging examinations [4 , 16] . Sometimes, PI presents mild symptoms, including abdominal discomfort, diarrhea, and hematochezia [1] .…”

“…Sometimes, PI presents mild symptoms, including abdominal discomfort, diarrhea, and hematochezia [1] . Severe clinical symptoms are generally observed in surgical emergencies such as ischemia, bowel necrosis, intestinal volvulus, and peritonitis [2 , 4 , 8] . However, in some clinical circumstances, the distinction between a surgical and nonsurgical situation may be difficult, due to overlap with other pathologies.…”

“…The presentation of these 2 symptoms together generally suggests the occurrence of life-threatening conditions, such as gastrointestinal perforation, ischemic bowel, and bowel necrosis [1] , [2] , [3] . However, some benign conditions can also cause this phenomenon, such as respiratory diseases, systemic diseases, immunodeficiency, several medications, postoperative, post-transplantation organs, and iatrogenesis [4] , [5] , [6] , [7] .…”