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Pneumatosis in post-Whipple patients
Lauren I Wikholm1, David K Imagawa
1Department of Surgery, Maricopa Medical Center, Phoenix, Arizona, USA.
The American Surgeon
|October 3, 2012
Summary
Pneumatosis intestinalis (PI) after Whipple procedures is linked to higher reoperation and death rates. Isolated PI can be managed nonoperatively, but peritonitis with PI indicates severe complications.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Radiology
Background:
- Pneumatosis intestinalis (PI) signifies air in the intestinal wall, with variable clinical importance.
- PI can range from incidental findings to indicators of critical illness necessitating surgery.
Purpose of the Study:
- To investigate the incidence and consequences of PI in patients undergoing Whipple procedures.
- To analyze the association between PI and outcomes such as reoperation and mortality.
Main Methods:
- Retrospective review of 214 patients undergoing Whipple procedures over 7 years.
- Analysis of demographic, imaging, and outcome data.
- Statistical comparison using two-tailed Fisher's exact test.
Main Results:
- Thirteen of 214 patients developed PI, predominantly with gastrojejunal feeding tubes.
- The PI group had a significantly higher reoperation rate (4/13 vs. 9/201, P<0.02) and 90-day death rate (23.3% vs. 2.9%, P<0.02).
- Four patients with PI required surgery due to peritonitis with necrotic bowel or gastrointestinal bleeding; nine were managed nonoperatively.
Conclusions:
- While isolated PI may be managed nonoperatively, its presence with peritonitis is a strong predictor of fatal complications.
- PI following Whipple procedures warrants careful monitoring and management consideration.
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