Pneumatosis Intestinalis in Patients With Severe Thermal Injury

Abstract

Severe thermal injury is associated with pronounced changes in intestinal physiology, which may cause ischemia, infarction, and pneumatosis intestinalis (PI). PI is a pathologic condition defined as infiltration of gas into the gastrointestinal tract wall. Historically, PI prompted urgent surgery, yet some surgeons "watch and wait" to avoid the risks of a negative laparotomy. The authors reviewed experience with PI at a single burn center. They retrospectively identified burn center intensive care unit patients with radiographic or pathologic evidence of PI. Data included demographics, injury severity score, TBSA burned, operative findings, length of stay, and mortality. From January 2003 through August 2009, 1129 patients were admitted to the authors' burn center intensive care unit. Fifteen had PI. Twelve had radiographic evidence of PI, and 10 had PI associated with intestinal infarction. Nonsurvivors had lower base deficits (P = .02), higher lactate levels (P = .05), and required vasopressor support (P = .02) within 24 hours of developing PI. Massive intestinal infarction (P = .004) and open abdomens (P = .004) were more common among nonsurvivors. PI can be identified by radiologic or pathologic findings. The authors' experience with PI among patients with burn injury revealed a high mortality rate. Because of the association of bowel ischemia with PI, exploratory laparotomy should be strongly considered in patients with burn injury with radiographic evidence of PI.

Non-occlusive mesenteric ischaemia: The prevalent cause of gastrointestinal infarction in patients with severe burn injuries

“…As described in several cases in the literature [16,20], computed tomography for our patients most often revealed an extended pneumatosis intestinalis, which resulted in rapid surgical intervention. At a median of three laparotomies, the group of NOMI survivors had more abdominal surgeries than those patients who did not survive this event.…”

Predisposing factors for candidemia in patients with major burns

“…was significantly associated with invasive fungal infection and the development of multiorgan failure in the critically ill surgical patient [24]. In particular burn patients are at risk for severe gastrointestinal complications such as intestinal ischemia and infarction [26][27][28][29]. A study published in the year 2009 identified 120 (6.6%) patients with abdominal pathologies among 1.825 burned patients [29].…”

Management of Pneumatosis Intestinalis in a Pediatric Burn Patient

“…6 The success of nonoperative management of PI has not carried over to adults as 94% of burn patients with PI were found to have intestinal ischemia. 1 Other findings indicative of poor outcomes with PI including portal venous gas, serum lactic acid greater than 2 mmol/L, and rectal bleeding. 1,2,6 Surgery should be reserved for complications including perforation, peritonitis, or abdominal sepsis.…”

“…The microbiologic theory involves bacterial entry through mucosal injuries and subsequent production of gas. 1,2 Other conditions associated with PI include immunocompromise, hypoalbuminemia, inhalation injury, and prolonged mechanical ventilation. 2 Our patient suffered from all of these conditions as a result of her extensive burn.…”