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Abstract

Objectives: We evaluated the incidence, clinical presentation, laboratory findings, possible causes, and outcomes associated with pneumatosis intestinalis in the setting of lung transplant. Materials and Methods: A departmental database showed that, between October 2002 and August 2013, our institution performed 373 lung transplants. The database was queried for all patients who had pneumatosis intestinalis and/or pneumoperitoneum after lung transplant at our institution. For this retrospective chart review, information collected included demographics, baseline variables, symptoms, signs, laboratory parameters, radiologic work-up, medications, including immunosuppressants at presentation, progress and time to resolution, length of hospital stay, and postoperative complications, as well as short-term and midterm outcomes (up to 1 year). Results: The incidence of pneumatosis intestinalis was 2.68% (10/373 patients). Mean age of patients was 52.2 years (range, 34.9-67.9 y). Mean time for development of pneumatosis intestinalis after transplant was 352.8 days (range, 5-2495 d). Abdominal symptoms and signs were present in 6 patients (60%). The large bowel was the site of involvement in all but 1 patient, with predilection for ascending colon (80%) and transverse colon (90%) in most patients. High serum lactate levels were found in 2 patients, and both underwent bowel resection, with surgical specimens revealing evidence of ischemic changes in the gut. Mean dose of prednisone was 22 mg at the time of presentation (range, 0-60 mg). Mean hospital length of stay was 16.9 days (range, 0-40 d). Short-term survival was 100%. Midterm survival at the end of 1 year was 80%. Mean time for pneumatosis to resolve was 18 days (range, 14-35 d). Conclusions: Pneumatosis intestinalis in bilateral lung transplant recipients can be treated with a minimal amount of imaging, and most patients can be treated conservatively. Survival outcomes are quite good, with 100% during the short term and 80% at 1 year in our series. Key words: Bowel resection, Pneumoperitoneum, Retrospective study, Survival IntroductionPneumatosis intestinalis (PI) is a bowel pathology defined as accumulation of gas in the submucosa or subserosa of the large or small intestine (Figure 1). It is seen in association with a number of diseases, but its pathogenesis is still obscure. It has shown an association with solid-organ and bone marrow transplant, 1-5 immunosuppressive drugs, especially steroids, 1,6,7

Pneumatosis Intestinalis in Adult Bilateral Lung Transplant Patients: A Single Institution Experience and Literature Review

“…There are multiple case reports and 2 small case series [ 5 , 6 , 9 , 10 ] that have previously been published on PI in the post lung transplant population. Thompson et al described 6 patients (out of 321, Table 2 ) with a rate of observation of 2% while Chandola et al described 10 patients (out of 373, Table 3 ) with a rate of 2.68% [ 5 , 6 ].…”