Pneumatosis intestinalis in abdominal CT: predictors of short-term mortality in patients with clinical suspicion of mesenteric ischemia

Simon D Graber,Matthias Turina,Stefanie Sinz,Hatem Alkadhi

doi:10.1007/s00261-022-03410-x

Abstract

PurposePneumatosis intestinalis (PI) in the bowel wall demonstrated in computed tomography (CT) of the abdomen is unspecific and its prognostic relevance remains poorly understood. The purpose of this study was to identify predictors of short-term mortality in patients with suspected mesenteric ischemia who were referred to abdominal CT and showed PI.MethodsIn this retrospective, IRB-approved, single-centre study, CT scans and electronic medical records of 540 patients who were referred to abdominal CT with clinical suspicion of mesenteric ischemia were analysed. 109/540 (20%) patients (median age 66 years, 39 females) showed PI. CT findings were correlated with surgical and pathology reports (if available), with clinical and laboratory findings, and with patient history. Short-term outcome was defined as survival within 30 days after CT.ResultsPI was found in the stomach (n = 6), small bowel (n = 65), and colon (n = 85). Further gas was found in mesenteric (n = 54), portal (n = 19) and intrahepatic veins (n = 36). Multivariate analysis revealed that PI in the colon [odds ratio (OR) 2.86], elevated blood AST levels (OR 3.00), and presence of perfusion inhomogeneities in other abdominal organs (OR 3.38) were independent predictors of short-term mortality. Surgery had a positive effect on mortality (88% lower likelihood of mortality), similar to the presence of abdominal pain (65% lower likelihood).ConclusionsOur study suggests that in patients referred for abdominal CT with clinical suspicion of mesenteric ischemia, location of PI in the colon, elevation of blood AST, and presence of perfusion inhomogeneities in parenchymatous organs are predictors of short-term mortality.Graphical abstract

Highlights

Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine, which is usually diagnosed with abdominal computed tomography (CT)
The mean age of the 109 patients referred to imaging with a clinical suspicion of mesenteric ischemia and PI on abdominal CT was 66 ± 15 years
PI is a frequent finding in abdominal CT, but its presence is rather unspecific [1,2,3] and the prognostic value of this sign on CT is not yet clearly defined

Summary

Introduction

Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine, which is usually diagnosed with abdominal computed tomography (CT). CT typically demonstrates a low density linear and/or bubbly pattern of gas within the bowel wall, which can be readily diagnosed with CT due to its high spatial resolution and multiplanar reformation capabilities [1,2,3]. PI may be an incidental finding associated with a benign etiology, whereas in others, it portends a life-threatening abdominal condition. The significance of PI usually depends on the nature and severity of the underlying etiology [4]. One of the most feared underlying conditions for PI is mesenteric ischemia, which is associated with a high morbidity and mortality [5]. Because of the wide array of clinical settings in which PI is encountered, it is recommended to interpret radiological findings together with the individual clinical presentation, laboratory findings and patient history, in order to ensure a correct diagnosis and to guide appropriate management [6]

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