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

Shah, A.; Furajii, H. Al; Ra, Chisei

doi:10.4253/wjge.v6.i11.564

Cited by 11 publications

(11 citation statements)

References 10 publications

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“…In case of several results on the same day, the one closest to the time of the MDCT acquisition was chosen. For the anamnestic data, any previous surgery and other interventions that were done 21 or fewer days before the MDCT examination were considered, since these may have been related to the PI seen on the images [17, 18, 20]. …”

Section: Methodsmentioning

confidence: 99%

“…Finally, PI can also occur with chronic obstructive pulmonary disease, or it may result from artificial ventilation with positive end-expiratory pressure, thus representing an incidental finding on MDCT without any need for treatment [1, 19, 20]. This so-called “pulmonary theory” has been explained by disruption of alveoli, followed by extension of gas through the mediastinum along the tissue planes and through the perivascular spaces into the bowel wall; however, definite proof is lacking [5, 9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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ObjectivesTo evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome.Method and MaterialsTwo 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.ResultsThe 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).ConclusionIn 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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Shah et al 5 highlighted two cases of symptomatic pneumatosis intestinalis after laparoscopic total colectomy that were managed conservatively. Both patients underwent emergency laparoscopic total colectomy for inflammatory bowel disease.…”

Section: Discussionmentioning

confidence: 99%

Case of pneumatosis intestinalis and hepatic portal venous gas following a laparoscopic right hemicolectomy

Castren¹,

Hakeem

Mahmood

et al. 2016

BMJ Case Reports

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Hepatic portal venous gas (HPVG) in most cases signifies either mechanical migration of air into the portal system due to bowel ischaemia (pneumatosis intestinalis) or portal sepsis due to gas-forming organisms. Successful management of portal sepsis involves early identification of the condition, intensive resuscitation, broad-spectrum antibiotics and a laparotomy for possible bowel ischaemia. In this report, we discuss the case of a patient with pneumatosis intestinalis and HPVG after an elective laparoscopic right hemicolectomy. After an initial slow recovery, on postoperative day seven, the patient had profuse diarrhoea and confusion, and was hyponatraemic. A CT scan revealed pneumatosis intestinalis and HPVG. A laparotomy showed no obvious cause for HPVG and there was no ischaemic bowel. She was managed with intensive care, hyperbaric oxygen therapy, broad-spectrum antibiotics and total-parenteral nutrition. She has made a good recovery. This case highlights the presenting features, differential diagnoses, and management of pneumatosis intestinalis and HPVG.

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“…Apart from these clearly life-threatening pathologies, benign / reversible causes like respiratory disorders and / or unfavourable drug related side effects -e.g. chemotherapy-associated -have been reported (10)(11)(12). Clinical presentation can be unspeci c, but the most common symptoms involve abdominal pain, diarrhoea, bloody stools, fever, and shock (1,13,14).…”

Section: Introductionmentioning

confidence: 99%

“…Yet, the role and prognostic relevance of gas ascending into the liver, causing porto-mesenteric venous gas (PMVG) remains unclear. PMVG has been both described as linked to increased mortality as well as a reversible phenomenon (1,10,(16)(17)(18)(19) (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Pneumatosis Intestinalis and Porto-Mesenteric Venous Gas: A Multicentre Study

Seta

Kloeckner²,

Santos

et al. 2021

Preprint

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Background: Estimating the prognosis of patients with pneumatosis intestinalis (PI) and porto-mesenteric venous gas (PMVG) can be challenging. The purpose of this study was to refine prognostication to improve decision making in daily clinical routine. Results: A total 290 patients with confirmed PI were included in the final analysis. The presence of PMVG and mortality (90d follow-up) were evaluated with regard to the influence of possible risk factors. Furthermore, a linear estimation model was devised combining significant parameters to calculate accuracies for predicting death in patients undergoing surgery by means of a defined operation point (ROC-analysis). Overall, 90d mortality was 55.2% (160/290). In patients with PI only, mortality was 46.5% (78/168) and increased significantly to 67.2% (82/122) in combination with PMVG (median survival: PI: 58d vs. PI and PMVG: 41d; p<0.001). In the entire patient group, 53.5% (155/290) were treated surgically. OS was >90d in 25% (72/90) of conservatively treated patients. In these cases PMVG/PI and was defined as “benign”/reversible. PMVG, COPD, sepsis, and low platelet count correlated with a worse prognosis. To identify patients deteriorating despite surgery, our calculation model reaches accuracies of 97% specificity, 20% sensitivity, 90% PPV and 45% NPV. Conclusion: Although PI is associated with high morbidity and mortality, „benign causes” are common. However, in concomitant PMVG, mortality rates increase significantly. Our mathematical model could serve as a decision support tool to identify patients who are least likely to benefit from surgery, and to potentially reduce overtreatment in this subset of patients.

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

Cited by 11 publications

References 10 publications

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

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

Case of pneumatosis intestinalis and hepatic portal venous gas following a laparoscopic right hemicolectomy

Pneumatosis Intestinalis and Porto-Mesenteric Venous Gas: A Multicentre Study

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