J Korean Surg Soc JKSS Journal of the Korean Surgical Society 1226-0053 2093-0488 The Korean Surgical Society 10.4174/jkss.2010.79.6.467 Original Article Clinical Review of Pneumatosis Intestinalis Min Sun Young M.D. Kim Jae Il M.D. Choi Pyong Wha M.D. Park Je Hoon M.D. Heo Tae Gil M.D. Lee Myung Soo M.D. Kim Chul Nam M.D. Chang Surk Hyo M.D. Kim Han Seong M.D. 1 Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. Corresponding author (erythrokim@paik.ac.kr) 12 2010 31 12 2010 79 6 467 473 23 06 2010 19 08 2010 Copyright © 2010 The Korean Surgical Society 2010 Purpose

Pneumatosis intestinalis (PI) is increasingly being detected in recent years with the more frequent use of computerized tomography (CT). The present study was performed to evaluate the clinico-radiologic characteristic presentation of PI and to determine the prognostic factors for mortality.

 Methods

Fifteen patients who were diagnosed with PI on CT between June 2000 and May 2010 were retrospectively reviewed. Age, sex, location of PI, presence of portal vein gas, time to diagnosis, American Society of Anesthesiologists (ASA) classification, Acute Physiology And Chronic Health Evaluation II (APACHE II), acidosis, shock, and other associated findings were analyzed for their association with outcome.

 Results

Fifteen patients (7 males and 8 females, average age, 60.3 years) were diagnosed with PI. Mortality rate was 47% (7 patients). The mortality rate in patients with septic shock, APACHE II score (18), acidosis (pH<7.36) were all 100%, 87%, 100%, respectively (P<0.05). Age, sex, location of PI, portal vein gas, time to diagnosis, ASA classification, associated findings did not show statistical difference.

 Conclusion

Shock, APACHE II score (18) and acidosis were associated with high mortality in patients with PI. So, more intensive management and interest are recommended in patients with shock, APACHE II score (18), and acidosis due to PI.

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CT finding of pneumatosis intestinalis. (A) Contrast enhanced CT scan shows linear gas collection involving long segment of distal ileum. (B) Lung window setting shows clearly gas in intramural space.

Operative finding of pneumatosis intestinalis. Small bowel is edematous and has necrotic change on distal ileum segment.

Pathologic finding of pneumatosis intestinalis. Bowel wall shows transmural hemorrhagic infarction (H&E stain, ×10).

Clinicoradiological characteristics of pneumatosis intestinalis

*Sx. = symptom; †ASA = American Society of Anesthesiologists; ‡APACHE II = acute physiology and chronic health evaluation II; §OP = operation; ∥R&A = resection and anastomosis.

Mortality case of pneumatosis intestinalis

*ASA = American Society of Anesthesiologists; †APACHE II = Acute Physiology And Chronic Health Evaluation II; ‡PVG = portal vein gas; §SMA = superior mesenteric artery; ∥SM = small bowel.

Analysis of prognostic factors for mortality of pneumatosis intestinalis

*PI = pneumatosis intestinalis; †ASA = American Society of Anesthesiologists; ‡APACHE II = Acute Physiology and Chronic Health Evaluation II; §Others = bowel perforation, enterotizing colitis, cancer obstruction, acute appendicitis, necrotizing colitis, ulcerative colitis, non-specific.