Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia

Milone, Marco; Minno, Matteo Nicola Dario Di; Musella, Mario; Maietta, Paola; Iaccarino, Vittorio; Barone, Giovanni; Milone, Francesco

doi:10.3748/wjg.v19.i39.6579

Cited by 48 publications

(31 citation statements)

References 26 publications

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“…When PMVG occurred together with PI, the ischemic origin was even more likely, also in agreement with our and other [34] results. Unfortunately, Lassandro et al did not take into account any radiological or clinical associated findings [33].…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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

et al. 2016

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“…When pneumatosis intestinalis is present along with portomesenteric gas, the specificity approaches approximately 100% for ischemic bowel. However, it is critical to note that in the absence of a clinical signs or symptoms of ischemia, the finding of isolated pneumatosis intestinalis should not trigger a definite diagnosis of intestinal ischemia (31-33). Pneumatosis intestinalis is not a specific finding of intestinal ischemia and may occur in a wide range of non-emergent benign scenarios [Figure 9].…”

Section: Arterial Ischemia –Bowel Wall Evaluationmentioning

confidence: 99%

Radiological Evaluation of Bowel Ischemia

Dhatt

Behr

Miracle

et al. 2015

Radiologic Clinics of North America

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Intestinal ischemia, which refers to insufficient blood flow to the bowel, is a potentially catastrophic entity that may require emergent intervention or surgery in the acute setting. Although the clinical signs and symptoms of intestinal ischemia are nonspecific, CT findings can be highly suggestive in the correct clinical setting. In this chapter we review the CT diagnosis of arterial, venous, and non-occlusive intestinal ischemia. We discuss the vascular anatomy, pathophysiology of intestinal ischemia, CT techniques for optimal imaging, key and ancillary radiological findings, and differential diagnosis. In the setting of an acute abdomen, rapid evaluation is necessary to identify intraabdominal processes that require emergent surgical intervention (1). While a wide-range of intraabdominal diseases may be present from trauma to inflammation, one of the most feared disorders is mesenteric ischemia, also known as intestinal ischemia, which refers to insufficient blood flow to the bowel (2). Initial imaging evaluation for intestinal ischemia is typically obtained with CT. Close attention to technique and search for key radiologic features with relation to the CT technique is required. Accurate diagnosis depends on understanding the vascular anatomy, epidemiology, and pathophysiology of various forms of mesenteric ischemia and their corresponding radiological findings on MDCT. At imaging, not only is inspection of the bowel itself important, but evaluation of the mesenteric fat, vasculature, and surrounding peritoneal cavity also helps improves accuracy in the diagnosis of bowel ischemia.

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“…Clinically, pneumatosis intestinalis is classified into primary and secondary pneumatosis intestinalis. Eightyfive percent of cases are classified as secondary 9) , and are associated with mucosal injuries caused by mesenteric infarction, mucosal injuries, systemic disease, and the use of steroids and other drugs that may induce the condition [1][2][3][4][5][6][7] . In the third patient in this series, the use of an α-glucosidase inhibitor, immunosuppressants, and corticosteroid were risk factors for the development of pneumatosis intestinalis.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumatosis intestinalis can be found incidentally in asymptomatic patients or identified in relation to various medical conditions, such as mesenteric infarction 1) , appendicitis 2,3) , systemic disease 4,5) , and the use of certain drugs (e.g. corticosteroids and α-glucosidase inhibitors) 6,7) .…”

Section: Introductionmentioning

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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Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia

Abstract: Although pneumatosis plus porto-mesenteric venous gas is associated with bowel ischemia, we have demonstrated that their co-occurrence cannot be used as diagnostic signs of transmural necrosis.

Cited by 48 publications

References 26 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

Radiological Evaluation of Bowel Ischemia

Pneumatosis intestinalis: report of three cases with different clinical features

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