Pneumatosis intestinalis and hepatic-portal-mesenteric venous gas in intestinal ischemia

Abstract

Objective: the purpose of this study was to report the authors' experience in the diagnosis, management, and clinical outcome of intestinal ischemia with pneumatosis intestinalis (PI) and hepatic-portal-mesenteric venous gas (HPMVG). Experimental design: a retrospective analysis. Method: the medical records of 12 cases of intestinal ischemia with PI and HPMVG spanning the last 10 years were reviewed. Clinical characteristics, imaging study results, surgical findings, histological findings, management, and clinical outcome were evaluated. Results: of the 12 cases that were evaluated, 9 patients presented with abdominal distension, three, with abdominal pain, five, with shock on admission, and six, with fever. Most patients (83%) had a history of diabetes mellitus. Dilated loops of bowel were identified on plain film radiography in 9 of 12 of patients. Only 3 cases were initially suspected of having abnormal gas over the RUQ or intramural intestine. All patients underwent abdominal computed tomography (CT). Nine patients were diagnosed with ischemic changes of the intestine (2 cases had colon involvement), and 3 patients were found to have a gangrenous intestine. While all patients underwent segmental resection of the intestine, ten of 12 patients died post-operatively. Conclusions: abdominal CT findings of PI and HPMVG in intestinal ischemia do not appear to either directly correlate with the gross findings or predict clinical outcome. The clinical outcome of patients affected with this condition was poor, even following surgical intervention. A positive clinical outcome may depend on the severity and extent of the underlying disease(s). Copyright © 2007 Arán Ediciones, S. L .