Management Algorithm for Pneumatosis Intestinalis and Portal Venous Gas: Treatment and Outcome of 88 Consecutive Cases

Wayne, Erik; Ough, Matthew; Wu, Andrew S.; Liao, Junlin; Andresen, Kelli; Kuehn, David M.; Wilkinson, Neal

doi:10.1007/s11605-009-1143-9

Cited by 154 publications

(234 citation statements)

References 22 publications

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“…Traditionally, portal venous gas is taken as a sign of poor prognosis or intestinal necrosis. Despite this, conservative treatment can still be applied successfully in selected patients 13,14) . Furthermore, it appears that the pattern and amount of portal gas is not necessarily related to the severity of the condition 14) .…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis: report of three cases with different clinical features

Akimori¹,

Kanagawa²,

Fujisawa³

et al. 2015

Ann. Cancer Res. Therap.

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Pneumatosis intestinalis is a condition characterized by the presence of gas within the wall of the small or large intestine. The causes, clinical features, and prognosis vary among individual cases, and careful assessment is crucial for appropriate treatment. Herein, we describe three cases of pneumatosis intestinalis with different clinical features. The small intestine was involved in two patients, whereas the ascending colon was involved in the third patient. Surgical intervention was chosen in two patients because of severe abdominal pain, decreased base excess, and the presence of portal venous gas (in one patient). However, there were no signs of intestinal necrosis on pathological examination. In the third case, computed tomography revealed free air within the peritoneum. Despite this, the patient was not experiencing any severe abdominal pain or deterioration of vital signs, and was treated successfully with fasting and antibiotics. The third patient was on several medications, such as immunosuppressant, prednisolone for cutaneous malignant lymphoma, and α-glucosidase inhibitor for diabetes mellitus, and the condition was suggested as drug-induced pneumatosis intestinalis.In conclusion, patients with pneumatosis intestinalis present with various clinical features from critical to mild conditions. Some are accompanied by severe signs such as portal venous gas, intraperitoneal free air, and metabolic acidosis, necessitating urgent intervention; contrarily, the other can be managed conservatively. For successful treatment, the evaluation of the severity of the disease and the accompanying conditions such as perforation and necrosis of the intestine is mandatory.

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Section: Discussionmentioning

confidence: 99%

Pneumatosis intestinalis: report of three cases with different clinical features

Akimori¹,

Kanagawa²,

Fujisawa³

et al. 2015

Ann. Cancer Res. Therap.

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“…While increasing use of CT imaging has led to quicker and earlier detection [9] , the increasing sophistication of this modality includes greater sensitivity for non-critical findings. Management decisions should therefore be based on a combination of both radiological and laboratory findings [10] but clinical examination (repeated frequently) and judgment is paramount.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic pneumatosis intestinalis (including portal venous gas) after laparoscopic total colectomy

Shah

Furajii

2014

WJGE

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The development of intramural intestinal gas may indicate a serious postoperative complication and therefore any radiological indication of such "pneumatosis intestinalis" (PI) in an unwell patient after surgery should put the clinical team on high-alert. However immediate recourse to relook laparotomy may not be always necessary and, further, in some cases may possibly accelerate the deterioration especially if it proves to be non-therapeutic. Careful and close clinical monitoring, as is described in this clinical report, may allow discriminative identification of those in whom this finding is in fact transient and therefore benign and who therefore can be successfully treated without operative re-intervention. We describe the presenting features and background scenario of PI early after laparoscopic total colectomy for medically refractory, severe ulcerative colitis and detail the critical postoperative decision pivots.

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“…It can extend from the esophagus to the rectum with the small bowel being most commonly affected [1]. With improvement in diagnostics there has been increased documentation of pneumatosis on computerized tomography (CT) scans [2] of the abdomen.…”

Section: Introductionmentioning

confidence: 99%

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

Muhammad

Sadough

King

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Pneumatosis intestinalis is a radiographic finding that represents a spectrum of conditions ranging from benign disease to abdominal sepsis and death. Along with portal venous gas, it is generally considered an ominous sign prompting emergency operative intervention. We report a rare case showing that nonoperative therapy can be considered in a seriously ill patient with esophageal, gastric and portal venous air.

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Management Algorithm for Pneumatosis Intestinalis and Portal Venous Gas: Treatment and Outcome of 88 Consecutive Cases

Cited by 154 publications

References 22 publications

Pneumatosis intestinalis: report of three cases with different clinical features

Pneumatosis intestinalis: report of three cases with different clinical features

Symptomatic pneumatosis intestinalis (including portal venous gas) after laparoscopic total colectomy

Pneumatosis of the esophagus and intestines with portal venous air: a rare presentation

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