Presence Of Portal Venous Gas Research Articles

Pneumatosis cystoides intestinalis: when the location of the air may be a pitfall

Pneumatosis cystoides intestinalis (PCI) is a rare and generally benign condition characterized by air within the walls of the small intestines or colon. Moreover, it may be a cause of free air in peritoneum. To correctly manage this entity when found at CT, it is of crucial importance for the radiologist to recognize and distinguish it from life-threatening causes of pneumatosis intestinalis or pneumoperitoneum. This differentiation may be challenging and the absence of additional findings (bowel wall thickening, altered contrast mucosal enhancement, fat stranding, dilated bowel, ascites, and the presence of portal venous gas) may be very helpful in suggesting the diagnosis. In this short communication we present a case of PCI in an asymptomatic 60-year old woman with a history of uterine carcinoma. The patient underwent a colonoscopy after a positive result of fecal occult blood test; the colonoscopy showed the presence of multiple grape-like nodules in the splenic flexure of the colon and biopsies were performed to exclude malignity of the findings. Then, a CT was conducted and it showed the presence of multiple, thin-walled, air-filled submucosal cysts in the splenic flexure of the colon. The endoscopic and CT findings, together with the absence of abdominal symptoms and altered laboratory test, allowed to establish the diagnosis of PCI. The patient was managed conservatively. Moreover, some free air bubbles were found in the pneumoperitoneum at one-year and two-year follow-up CTs, without abdominal symptoms.

Gastric Pneumatosis with Portal Venous Gas can be Treated Non-operatively: A Retrospective Multi-institutional Study.

Gastric pneumatosis (GP) is a rare radiologic finding with an unpredictable prognosis. The aim of this study was to identify mortality risk factors from patients presenting with GP on computed tomography (CT), and to develop a model which would allow us to predict which patients would benefit most from operative management. Between 2010 and 2020, all CT-scan reports in four tertiary centers were searched for the following terms: "gastric pneumatosis," "intramural gastric air" or "emphysematous gastritis." The retrieved CT scans were reviewed by a senior surgeon and a senior radiologist. Relevant clinical and laboratory data for these patients were extracted from the institutions' medical records. Among 58 patients with GP, portal venous gas and bowel ischemia were present on CT scan in 52 (90%) and 17 patients (29%), respectively. The 30-day mortality rate was 31%. Univariate analysis identified the following variables as predictive of mortality at the time of the diagnosis of GP: abdominal guarding, hemodynamic instability, arterial lactate level >2mmol/l, and the absence of gastric dilatation. Multivariable analysis identified the following variables as independent predictors of mortality: arterial lactate level (OR: 1.39, 95% CI: 1.07-1.79) and the absence of gastric dilatation (OR: 0.07, 95% CI: 0.01-0.79). None of the patients presenting with a baseline lactate rate<2mmol/l died within 30days following diagnosis, and no more than 17 patients out of 58 had bowel ischemia (29%). GP could be managed non-operatively, even in the presence of portal venous gas. However, patients with arterial lactate level>2mmol/l, or the absence of gastric dilation should be surgically explored due to a non-negligible risk of mortality.

Predictive Indicators for Necrotizing Enterocolitis With the Presence of Portal Venous Gas and Outcomes of Surgical Interventions.

Objectives: Portal venous gas (PVG) was an important clinical sign in stage II or III necrotizing enterocolitis (NEC) in preterm neonates. Not a proper predictive indicator was found to predict the diseases (NEC with the presence of PVG) up to now. There is a need to put forward predictive indicators and compare the predictive effects among them.Methods: We conducted a retrospective study of preterm neonates with NEC-PVG (n = 61) or NEC-non PVG (n = 62) from 2014 to 2021. Predictive indicators were put forward and determined by receiver operating characteristic curve analysis. An analysis of the surgical interventions and their outcomes was performed.Results: The incidence rate of NEC among preterm neonates was 4.99%; surgical and conservative interventions accounted for 20.47 and 75.07%, and the mortality rate was 0.03%. The composition ratio of shock in the NEC-PVG group increased 13.2% (P = 0.029). C-reactive protein, fibrinogen degradation product, and blood glucose had better predictive effects in the predictive indicators (P < 0.05). Intestinal necrosis and subependymal hemorrhage in the outcomes of surgical interventions had a strong relationship with the presence of PVG in NEC II/III (P < 0.05).Conclusion: Early and reasonable use of antibiotics, improvement of coagulation function, rectification of acidosis, and decreased blood glucose could cut down the occurrence of the disease (NEC with the presence of PVG). Except for subependymal hemorrhage and intestinal necrosis, NEC with the presence of PVG did not increase the occurrence of other outcomes after surgery.

What Is the Role of Upper Endoscopy in Patients With Gastric Pneumatosis?

Gastric pneumatosis is a rare finding. It can be seen with both gastric emphysema and emphysematous gastritis. Both may have similar presentations and differentiating between the two conditions is difficult radiographically. However, making the distinction between them is crucial; as GE has a benign clinical course while EG is more maleficent, and carries significant mortality. Early endoscopy may help differentiate between the two processes. We present a series of two immunocompromised patients that presented with radiographic findings consistent with gastric pneumatosis. A 52 y.o male with history of HIV, diabetes, and dialysis dependent end-stage renal disease presented with a 3-day history of epigastric fullness, vomiting, and chills. He was febrile at 101.6F and his abdominal exam revealed mild distension, active bowel sounds with no appreciable tenderness. CT abdomen revealed a distended stomach with air within the gastric wall as well as the presence of portal venous gas. Endoscopy was performed on the 2nd day of hospitalization and showed erythematous gastric mucosa in the body and antrum. He improved with conservative measures including antibiotics and was eventually discharged. The second case was a 58 y.o female with history of stage 4 squamous cell lung carcinoma with bony metastases, ESRD on dialysis, systolic heart failure, and diabetes who presented with left hip pain and found to have left proximal femur erosion with effusion and was admitted for hemiarthroplasty. On POD #1 she became unstable and was transferred to the MICU. A CT abdomen revealed portal venous gas with pneumatosis of the stomach and adjacent duodenum. Endoscopy performed the same night revealed a diffusely ulcerated, edematous hemorrhagic gastric mucosa sparing the pre-pyloric region. The patient was a poor surgical candidate and was subsequently managed medically. Despite resuscitative efforts the patient experienced cardiac arrest and expired. Treatment for GE is supportive as this condition tends to be self limiting. Management of EG is more active including correction of acid-base and electrolyte abnormalities, fluid resuscitation and IV antibiotics. Gastrectomy may be necessary in EG if medical management fails. As both conditions can present similarly differentiating between the two is pivotal. We found early endoscopy helped guide our management. We recommend consideration of endoscopy as part of the evaluation of patients presenting with gastric pneumatosis.2622_A Figure 1. Coronal CT image showing portal venous gas with pneumatosis of the stomach and the adjacent duodenum2622_B Figure 2. Transverse CT image showing portal venous gas with pneumatosis of the stomach and the adjacent duodenum

PORTAL VENOUS GAS – RARE DIAGNOSTIC SIGN OF ABDOMINAL COMPARTMENT-SYNDROME

Portal venous gas in adults is associated with the development of abdominal compartment syndrome and can be used as a probable ultrasound diagnostic criterion. The case presents a patient aged 46 years after orthotopic heart transplant who developer abdominal syndrome in the intensive care unit postoperatively. Portal venous gas was a random finding during routine abdominal cavity ultrasound examination. Portal venous gas is a prognostically unfavorable sign. The early diagnosis can reduce the associated risk of death. Routine use of bedside ultrasound allows timely and accurately determining the presence of portal venous gas.

Benign Pneumatosis Intestinalis

A 28-year-old healthy woman presented to the hospital with abdominal discomfort. She complained of colic type abdominal pain and bloat of 3 days' duration, associated with a 1-day history of nausea and nonbilious vomiting. There was no change in frequency of her bowel habits and she was able to pass flatus. On physical examination, all her vital signs were within normal limits. The abdominal examination was essentially normal except for generalized mild abdominal tenderness with no signs of peritonitis. Laboratory investigations were unremarkable. A plain radiograph (Figure A) and computerized tomography scan (Figures B and C) showed extensive pneumatosis coli throughout the nondilated colon, from the cecum to the splenic flexure, with scattered free intraperitoneal and retroperitoneal gas pockets. No intra-abdominal collection or portal venous gas was seen. The patient was treated conservatively with intravenous antibiotics and was discharged from the hospital after 2 days with oral antibiotics. She remained well on outpatient follow-up evaluation. Pneumatosis intestinalis (PI) is a radiologic finding, defined by the presence of gas in the bowel wall. Various hypotheses have been proposed regarding the pathophysiology of PI, although the exact mechanism remains unknown.1Ho L.M. Paulson E.K. Thompson W.M. Pneumatosis intestinalis in the adult: benign to life- threatening causes.AJR Am J Roentgenol. 2007; 188: 1604-1613Crossref PubMed Scopus (248) Google Scholar PI can occur as a primary idiopathic condition or secondary to an underlying condition. The latter may be subdivided into benign and life-threatening causes.1Ho L.M. Paulson E.K. Thompson W.M. Pneumatosis intestinalis in the adult: benign to life- threatening causes.AJR Am J Roentgenol. 2007; 188: 1604-1613Crossref PubMed Scopus (248) Google Scholar, 2Wu L.L. Yang Y.S. Dou Y. et al.A systemic analysis of pneumatosis cystoids intestinalis.World J Gastroenterol. 2013; 19: 4973-4978Crossref PubMed Scopus (106) Google Scholar Benign conditions include pulmonary diseases such as asthma and chronic obstructive pulmonary disease, systemic lupus erythematosus, and the use of medications such as corticosteroids or chemotherapeutic agents. Life-threatening conditions that may cause PI include intestinal obstruction and intestinal ischemia. Patients with primary idiopathic and secondary benign PI are usually asymptomatic and are diagnosed incidentally through radiologic imaging. Patients with secondary life-threatening causes of PI are usually symptomatic and require surgical intervention.1Ho L.M. Paulson E.K. Thompson W.M. Pneumatosis intestinalis in the adult: benign to life- threatening causes.AJR Am J Roentgenol. 2007; 188: 1604-1613Crossref PubMed Scopus (248) Google Scholar, 2Wu L.L. Yang Y.S. Dou Y. et al.A systemic analysis of pneumatosis cystoids intestinalis.World J Gastroenterol. 2013; 19: 4973-4978Crossref PubMed Scopus (106) Google Scholar A computerized tomography scan is the most sensitive imaging test for the identification of PI and is also useful to identify the underlying cause.1Ho L.M. Paulson E.K. Thompson W.M. Pneumatosis intestinalis in the adult: benign to life- threatening causes.AJR Am J Roentgenol. 2007; 188: 1604-1613Crossref PubMed Scopus (248) Google Scholar The main challenge in the management of PI hinges on the identification of patients who require surgical intervention.1Ho L.M. Paulson E.K. Thompson W.M. Pneumatosis intestinalis in the adult: benign to life- threatening causes.AJR Am J Roentgenol. 2007; 188: 1604-1613Crossref PubMed Scopus (248) Google Scholar, 2Wu L.L. Yang Y.S. Dou Y. et al.A systemic analysis of pneumatosis cystoids intestinalis.World J Gastroenterol. 2013; 19: 4973-4978Crossref PubMed Scopus (106) Google Scholar Patients who present with clinical and laboratory features of an acute abdomen should undergo an immediate exploratory laparotomy. Clinical features found to be predictive of the need for surgical intervention include the following: history and physical examination findings suggestive of an acute abdomen, metabolic acidosis, increased serum lactate level, increased serum amylase level, or the presence of portal venous gas.3Knechtle S.J. Davidoff A.M. Rice R.P. et al.Pneumatosis intestinalis. Surgical management and clinical outcome.Ann Surg. 1990; 212: 160Crossref PubMed Scopus (179) Google Scholar Most cases of PI can be managed conservatively with treatment targeted at the underlying cause, especially in cases secondary to benign conditions.2Wu L.L. Yang Y.S. Dou Y. et al.A systemic analysis of pneumatosis cystoids intestinalis.World J Gastroenterol. 2013; 19: 4973-4978Crossref PubMed Scopus (106) Google Scholar Conservative management may entail antibiotic therapy, elemental diet, supplemental/hyperbaric oxygen therapy, or endoscopic therapy of cysts to relieve obstruction.2Wu L.L. Yang Y.S. Dou Y. et al.A systemic analysis of pneumatosis cystoids intestinalis.World J Gastroenterol. 2013; 19: 4973-4978Crossref PubMed Scopus (106) Google Scholar However, because of the rarity of the condition, there remains little evidence to date supporting any of the treatment modalities.

Infantile Hypertrophic Pyloric Stenosis - A Rare Cause of Hepatoportal Venous Gas

Hepatic portal venous gas (HPVG) is usually associated with necrotizing enterocolitis or bowel ischemia in infants but it’s a rare finding with hypertrophic pyloric stenosis (HPS). In such cases, portal venous gas is a benign incidental finding and does not advocate any delay in the surgical treatment. We report this atypical case of 3 weeks old male infant with HPS having portal venous gas that was detected on abdominal ultrasound. Our patient with a history of term delivery was brought to the pediatric department of Combined Military Hospital Lahore on 25th of November, 2013 with complaints of vomiting and constipation for the last 4 days. Physical examination showed that the infant was lethargic and mildly dehydrated with soft and non-tender abdomen. Baseline blood tests revealed metabolic alkalosis with hemoglobin and total leukocyte count within normal limits. Plain xray abdomen showed a distended stomach with no signs of gut obstruction. Abdominal ultrasonography revealed a severely thickened and lengthened pylorus suggestive of hypertrophic pyloric stenosis. Moreover, ultrasound also showed multiple echogenic foci diffusely involving the both lobes of otherwise normal sized liver. Moving air bubbles were also detected in the extra and intra hepatic portal and splenic veins on dynamic scanning confirming the presence of portal venous gas. The infant underwent Ramstedt’s pyloromyotomy for HPS. The infant showed a steady recovery and ultrasonography performed at 2nd post op day detected no signs of gas within the hepato portal veins.

Portal Venous Gas on Computed Tomography Imaging in Patients with Decompression Sickness

BackgroundIt has been reported that portal venous gas is rarely found on computed tomography (CT) imaging in patients with decompression sickness (DCS). However, we propose that this is not true because we have encountered several patients with DCS who presented with portal venous gas on CT before hyperbaric oxygen therapy (HBOT). Here, we review our charts and present these patients’ characteristics. CasesWe treated 37 patients with DCS from April 2007 to September 2011. Nine of these 37 patients underwent CT (thoracic, abdominal, or both) on admission because of dyspnea and other reasons. In four of nine patients, portal venous gas was incidentally found on CT. All patients were male, and three of them were SCUBA (self-contained underwater breathing apparatus) divers. Most of the patients did not have abdominal complaints. Three of four patients presented with gas in other abdominal areas (e.g., mesentery or inferior vena cava). HBOT (United States Navy Treatment Table 6) was performed in all patients, and abdominal CT performed after HBOT in three of four patients revealed the complete disappearance of portal venous gas and other venous gases. One patient died, and the remaining patients survived without any complications. ConclusionsMost patients with DCS do not require CT examination before HBOT. However, if all patients with DCS undergo abdominal CT, the presence of portal venous gas in these patients may no longer be a rare finding. Although routine CT is not required for patients with DCS, it might be helpful for diagnosis.

Portal Venous Gas: A Clinical Finding in Obstructed Infracardiac Total Anomalous Pulmonary Venous Connection

Total anomalous pulmonary venous connection is a cyanotic congenital heart defect that presents with a multitude of clinical presentations. We report a case of obstructive total anomalous pulmonary venous connection (TAPVC) which presented in a way that has not previously been described. An infant with mixed type obstructive TAPVC was found to have pulmonary interstitial emphysema and portal venous gas on a scout radiograph obtained prior to computed tomography scan. The presence of portal venous gas indicated a connection between the pulmonary venous system and the portal venous system infradiaphragmatically.

Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie's syndrome) in a child

We report a case of a 10-year-old girl presenting with portal venous gas and thrombosis associated with superior mesenteric artery syndrome. To our knowledge, this is the first reported case of superior mesenteric artery syndrome complicated by gastric wall pneumatosis, portal venous gas, and thrombosis in childhood. Although these complications usually lead to bowel resection in adults and result in a high mortality rate, our pediatric patient was successfully treated nonoperatively with intensive care management and jejunal tube feedings. Presence of portal venous gas may occur in superior mesenteric artery syndrome in children and does not necessarily lead to bowel injury, allowing conservative medical management as a first-line treatment.

Portal Venous Gas Detected on Computed Tomography in Emergency Situations: Surgery Is Still Necessary

Portal venous gas (PVG) has been reported to be associated with lethal surgical diagnosis. Recent studies tend to confirm the clinical significance of gas in the portal vein; however, some patients are managed without surgical treatment. The aim of this study was to assess both the diagnoses and the treatment of patients with PVG in an emergency surgical setting. We performed a retrospective chart review of 15 patients with PVG in the emergency setting detected by computed tomography (CT) between July 1999 and July 2004. Characteristics assessed included age, sex, clinical presentation, first CT diagnosis of both PVG and the underlying pathology, American Society of Anesthesiologists (ASA) score, surgical findings, final clinical diagnosis, duration of hospitalization, and evolution of the illness/mortality. All patients were examined one month after operation. This series of 5 women and 10 men ranged in age from 38 to 90 years at the time they underwent emergency surgical treatment. The mean preoperative ASA score was 4.20. Computed tomography diagnosed the underlying pathology in all cases: bowel obstruction (4 cases), bowel necrosis (9 cases), and diffuse peritonitis (2 cases). The mean length of hospital stay was 12.4 days. The mortality rate was 46.6%; (7 patients). A wide range of pathologies can generate PVG. Computed tomography can detect both the presence of gas and the underlying pathology. In emergency situations, all the diagnosed causal pathologies required a surgical procedure without delay. We report that the prognosis was related to the pathology itself and was not influenced by the presence of PVG.

Radiofrequency Ablation of Liver Tumors: A New Cause of Benign Portal Venous Gas

To retrospectively describe and categorize the presence of portal venous gas (PVG) from radiofrequency (RF) ablation of hepatic tumors. The study was HIPAA compliant, and informed consent was waived. Thirty-four consecutive computed tomography (CT)-guided percutaneous RF ablations of liver tumors in 26 patients (13 men, 13 women; mean age, 69 years) with five hepatocellular carcinomas and 21 metastatic liver tumors (13 colon, five other, and three unknown primary tumors) were performed with an institutional review board-approved protocol. Two treatment modalities were used: RF ablation alone (13 procedures) and combined RF ablation and ethanol injection (21 procedures). Presence of PVG was quantified with three parameters: maximum length of a portal venous branch with gas, number of Couinaud segments in which PVG was seen, and total number of portal venous branch points with gas. Then an overall PVG score from 0 to 5 was determined. Also, when tumoral gas was seen on CT scans, the largest cross-sectional area of gas was measured. The two ablation methods were compared for quantities of PVG and tumoral gas. The role of N(2)O anesthetic in PVG and tumoral gas formation during ablation also was studied. Statistical analyses were performed with Wilcoxon rank sum and Student t tests. In 25 procedures (74%), gas was found in portal vein branches; in 30 procedures (88%), gas was also found in tumoral and peritumoral tissues. There was no significant difference in frequency of PVG between the ablation methods. Combined therapy yielded significantly greater lengths of PVG (P < .002) and more portal venous branch points (P < .001) than did RF ablation alone. Mean PVG score was 2.4 +/- 0.4 (standard error of the mean) for combined therapy and 0.9 +/- 0.2 for RF ablation alone (P < .004). N(2)O anesthetic was associated with greater amounts of tumoral gas (P < .008) and PVG (P < .03). Tumoral gas, peritumoral gas, and PVG dissipated within 20 minutes after ablation in all patients. No morbidity or mortality was associated with PVG. RF ablation is a common yet benign cause of transient PVG, tumoral gas, and peritumoral gas. Combined RF and ethanol ablation was associated with more PVG than was RF ablation alone.

Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis

Purpose The prognostic significance of portal venous gas (PVG) in neonatal necrotizing enterocolitis (NEC) for operative intervention (OP), neonatal complications, and mortality remains uncertain. The authors designed a long-term prospective study to describe the natural history of PVG related to these outcomes and to test the hypothesis that PVG does not mandate OP. Methods All infants admitted to a single center between October 1991 and February 2003 were evaluated weekly to identify all cases of NEC (defined as Bell stage II or higher). Demographic, radiological, surgical, and outcome data were abstracted prospectively. Radiographic studies were performed at the onset of illness and at subsequent 6- to 8-hour intervals or as clinically indicated. A single pediatric radiologist reviewed all radiographs. Values are expressed as mean ± SD. Odds ratios and relative risk ratios are reported with 95% CIs. The level of significance was P ≤ .05. Results After the exclusion of 24 infants with lethal diseases, major congenital or chromosomal anomalies, or recurrent episodes of NEC, 194 of 5891 infants developed NEC. The overall incidence of NEC was 3.7%. In 194 infants with NEC, the incidence of PVG was 33% (n = 64). Gestational age (30.8 ± 4 vs 29.3 ± 4.2 weeks; P = .02) but not birth weight (1609 ± 761 vs 1434 ± 810 g; P = NS) was greater in infants with PVG compared with infants without PVG (n = 130). Sixty-six (34%) infants with NEC underwent OP. Operative intervention occurred more frequently in infants with PVG compared with infants without PVG (OR, 2.5; CI, 1.37-4.76; P = .003)—only 48% of infants with PVG underwent OP. Among the variables, gestational age, severe NEC (Bell stage III), severe intramural gas (in all 4 abdominal quadrants), and the presence of PVG, severe NEC was most highly associated with OP (OR, 77.47; CI, 10.36-580.16; P < .0001). Bell stage III NEC was present in 98% of infants who underwent OP compared with 40% of infants without OP ( P < .0001). Of all infants with NEC, 37 (19%) died. Mortality was higher among infants who underwent OP (33% vs 12%; P < .0003). A multivariate regression model identified Bell stage III (OR, 3.74; CI, 1.20-11.62; P = .02), but neither PVG nor OP, to be significantly associated with mortality. Of interest is that survival in infants with PVG was greater (but not significantly so) than in infants without PVG in both OP (74% vs 59%) and non-OP (91% vs 87%) groups. Furthermore, 30 of 64 (47%) infants with PVG survived without OP, and of all 33 infants with PVG who did not undergo OP, 30 (91%) infants survived. Conclusions Decision for OP should be based on the severity of NEC and not on the presence of PVG alone because nearly half of infants with PVG survive without OP. Overall, the presence of PVG does not increase the risk of mortality among infants with NEC. Severe NEC, but not OP, is associated with higher mortality.

Inter-observer reliability of radiological signs of necrotising enterocolitis in a population of high-risk newborns.

Radiological examination of the abdomen is critical to the diagnosis of necrotising enterocolitis (NEC). Previous studies on the reproducibility of radiological findings have been limited in size and based only on infants with the disease. We conducted a study among a sample of high-risk infants with and without the diagnosis of NEC: (1) to measure the degree of inter-observer agreement of NEC radiological diagnosis and signs and (2) identify a profile of radiological signs which led the observers to make a diagnosis of NEC. We collected 297 X-rays from a sample of 57 newborns admitted in 1999 to neonatal intensive care and neonatal surgery units in Rome, Italy. Three specialists in paediatric radiology examined the films independently and without any clinical information about patients. The analyses were conducted on a total of 891 forms filled in by the observers. Kappa values were calculated to measure the inter-observer reliability. To identify the profiles of radiological signs, a multidimensional analysis, binary segmentation, was carried out. The reproducibility of radiographic signs was 0.55 (P < 0.01) for diffuse gaseous intestinal distention, 0.22 (P < 0.01) for bowel wall thickening, 0.10 (P < 0.01) for presence of portal venous gas and 0.29 (P < 0.01) for pneumatosis intestinalis. The agreement for radiographic diagnosis suspected/confirmed of NEC was 0.31 (P < 0.01). Among the 23 possible combinations of radiographic signs, the three radiologists indicated four profiles that produced a diagnosis of NEC containing, respectively, two, three, four and five signs. Our study found, in a large sample of radiographs selected from a population of infants with and without NEC, a poor reliability for NEC diagnosis and individual radiological signs among three expert radiologists. Clinical information and the presence of more than one radiological sign can reduce the margin of observer's error that inevitably exists when dealing with a diagnosis as difficult as NEC.

The significance of pneumatosis intestinalis or bowel perforation in patients with gynecologic malignancies.

The objectives of this study were to evaluate the clinical significance and outcome of pneumatosis intestinalis or bowel perforation in patients with gynecologic malignancies. A retrospective review of all gynecologic oncology patients at our institution from 1996 to the present was performed to identify computed tomography examinations showing pneumatosis, free air, or the presence of portal venous gas. Admission symptoms, laboratory testing, radiographic and operative findings, and overall survival were evaluated. At the discretion of the attending gynecologic oncologist, patients were managed either surgically or conservatively. Statistical analysis was performed with Fisher's exact test. Twenty-eight patients met study criteria. Thirteen patients were excluded as a result of radiographic free air immediately following surgery, thus leaving 15 patients for analysis. Sixty percent (n = 9) of patients were managed surgically while 40% (n = 6) were managed conservatively. Pain and tenderness at presentation prompted surgical intervention in a statistically significant number of patients (P = 0.04). No other sign or symptom was significant. Of the 6 patients managed conservatively, 3 (50%) died within 1 week of diagnosis. Survival for the others was 2, 4, and 6 months. Of the 9 patients managed surgically 6 (67%) patients died, 4 within 2 weeks of surgery and the remainder at 2 and 12 months postoperatively. The 3 patients who survived all had surgical intervention and none had radiographic or pathologic evidence of cancer at the time of presentation (P = 0.01). Overall mortality at 6 months was 73% (11/15). Surgical management was associated with prolonged ICU care, mechanical ventilation, and sepsis. Pneumatosis intestinalis and bowel perforation carry a grave prognosis for patients with gynecologic malignancies. These data suggest that patients explored for radiographic evidence of pneumatosis or perforation with preoperative evidence of active malignancy do not survive the immediate postoperative period. The balance between quality and quantity of life must be considered when weighing the options for the management of this condition.

Pneumatosis intestinalis in non-neonatal pediatric patients.

To describe fully pneumatosis intestinalis (PI) in non-neonatal pediatric patients and to characterize those patients with higher risk of poor outcome, including need for surgery and death. A retrospective chart review was conducted of all patients 30 days of age and older with PI in a tertiary care children's hospital during an 8-year period. Underlying medical condition, presenting signs and symptoms, radiologic grade of pneumatosis, and events that immediately preceded the onset of PI were reviewed, and their correlation with outcome was assessed. Thirty-seven episodes of PI occurred in 32 patients. Seventy-eight percent of patients were male, and the median age was 29 months. Major patient diagnostic groups identified with PI included healthy children (22%), patients with organ and bone marrow transplant (22%), patients with decompensated congenital heart disease (12.5%), motility disorders (12.5%), gastroschisis (9%), and short bowel syndrome (6%). The most common events that immediately preceded the onset of PI were noninfectious colitis (32%), acute enteric infection or toxin (27%), bowel ischemia (20%), and gastrointestinal dysmotility (17%). Resolution of PI with medical management occurred in 78% of episodes (good outcome). Twenty-two percent of episodes resulted in a poor outcome: patient death (8%) or surgery (14%). The presence of portal venous gas and low mean serum bicarbonate concentration were the only clinical factors that correlated significantly with poor outcome. Only 25% of patients with pneumoperitoneum required surgery. Poor outcome was seen most commonly in 2 patient diagnostic groups: transplant patients (43% of patients) and decompensated cardiac disease (50% of patients). The event that preceded PI also had an impact on outcome. PI preceded by ischemia or graft versus host disease colitis was associated with poor outcome in 50% and 75% of cases, respectively. PI is a radiologic sign that occurs in a variety of settings in non-neonates. PI preceded by bowel ischemia or graft versus host disease colitis has the worst prognosis, and the presence of portal venous gas and acidosis correlate with poor outcome. Not all patients with pneumoperitoneum require surgical intervention. Overall, outcome of PI in non-neonatal patients was better than that reported in neonates with necrotizing enterocolitis.pneumatosis intestinalis, necrotizing enterocolitis, non-neonatal.

Pneumatosis intestinalis in adults with AIDS: clinical significance and imaging findings.

The significance of pneumatosis intestinalis in adults with AIDS is unknown. Adults with AIDS are predisposed to pneumatosis intestinalis. The purpose of this study is to determine the clinical significance and to characterize the imaging appearance of this finding in patients with AIDS. In just over 3 years at our institution, pneumatosis intestinalis in adults with AIDS was detected in six cases. Medical records of those cases were retrospectively analyzed for clinical history, laboratory data, and surgical and pathologic findings. CT scans and abdominal radiographs were analyzed for location and severity of pneumatosis, presence of portal venous gas, pneumoperitoneum, and cystic versus linear gas. Five of the six patients with AIDS-associated pneumatosis intestinalis were managed conservatively or medically without surgical procedures and were discharged from the hospital with resolved or decreasing gastrointestinal complaints. The other patient underwent an exploratory laparotomy because of free intraperitoneal and retroperitoneal air; however, no bowel perforation was found at surgery. Pneumatosis intestinalis is a late-stage phenomenon in adult patients with AIDS that characteristically involves the cecum or right colon. Pneumatosis in patients with AIDS may be an indolent abnormality and does not necessarily constitute a surgical emergency or a sign of impending bowel necrosis.

Hepatic Portal Venous Gas Identified by Computed Tomography in a Patient with Blunt Abdominal Trauma:

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed becaused of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.

Hepatic Portal Venous Gas Identified by Computed Tomography in a Patient with Blunt Abdominal Trauma:

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed because of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.

Portal venous gas in the pediatric age group: Review of the literature and report of twelve new cases

Thirty-one reported instances of portal venous gas are reviewed, and 12 newcases are added. The presence of portal venous gas is usually associated with sepsis, gastroenteritis, and abdominal distention in the first few weeks of life. The roentgenographic findings are typical and diagnostic. Ths pathogenesis is not completely understood, although in most situations underlying gastrointestinal mucosal destruction is found. Since the condition in reported cases has been almost uniformly fatal, a vigorous medical and surgical therapeutic approach is suggested.