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

Sujin Ko,Hyun-Joo Kim,Yun-Woo Chang,Seong Sook Hong,Jiyoung Hwang,Eunji Lee

doi:10.1590/1806-9282.64.06.543

Sujin Ko, Hyun-Joo Kim + Show 4 more

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https://doi.org/10.1590/1806-9282.64.06.543

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Abstract

To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. 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. 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. 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.

Highlights

Pneumatosis intestinalis (PI) is a radiographic or physical finding characterized by gas infiltration into the wall of the intestine
The computed tomography (CT) findings including bowel distension, decreased bowel wall enhancement, portal venous gas (PVG), and ascites were significantly more commonly identified in the life-threatening group
No significant correlation was seen between both patient groups in the analysis of CT findings, such as bowel wall defect, extraluminal free air, and mesenteric venous gas (MVG) (Fig.2)

Summary

Introduction

Pneumatosis intestinalis (PI) is a radiographic or physical finding characterized by gas infiltration into the wall of the intestine. The clinical significance of PI can vary as it is the result of benign or life-threatening medical conditions and can be an incidental finding[1,2,3]. BENIGN VERSUS LIFE-THREATENING CAUSES OF PNEUMATOSIS INTESTINALIS: DIFFERENTIATING CT FEATURES cases associated with portomesenteric venous gas[9] or pneumoperitoneum[1,2,10]. 15-19 PI induced by these non-ischemic causes commonly show a benign clinical course and require conservative management rather than surgery. Due to the increased incidence of PI and an increased number of causes, including both life-threatening and benign ones, it is still confusing to select the most appropriate treatment option in clinical practice. An evaluation for the specific cause of PI is clinically important to reduce unnecessary surgery, leading to improved clinical outcomes of the patients

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