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Pneumatosis Intestinalis in Patients Receiving Tube Feeds
Insights
Pneumatosis intestinalis in patients with feeding tubes can indicate serious conditions. Free fluid on CT, elevated BUN/creatinine, and vomiting predict the need for intervention, guiding clinical decisions.
Area of Science:
- Medical Imaging
- Gastroenterology
- Surgical Critical Care
Background:
- Pneumatosis intestinalis (PI) on computed tomography (CT) often signifies underlying bowel pathology, including ischemia.
- Patients on tube feeds are susceptible to PI, which may necessitate surgical intervention.
- Predicting which PI cases require immediate intervention versus observation is clinically significant.
Purpose of the Study:
- To identify clinical factors associated with pneumatosis intestinalis in patients receiving tube feeds.
- To differentiate between benign and pathologic etiologies of PI in this patient population.
- To guide clinical decision-making regarding observation versus surgical intervention for PI.
Main Methods:
- Retrospective review of patients with CT-identified PI and an enteric feeding tube (2008-2016).
- Exclusion of patients not receiving tube feeds within one week of CT.
- Analysis of clinical, operative, and outcome data to distinguish benign from pathologic outcomes.
Main Results:
- Sixteen of 40 patients (40%) required intervention (pathologic outcome).
- Pathologic PI was associated with free fluid on CT (OR=5.00), elevated BUN (OR=8.27), elevated creatinine (OR=5.00), BUN/Cr ratio >30 (OR=8.57), and vomiting/feeding intolerance (OR=9.38).
- Bowel function, bowel dilatation, and lactic acidemia were not significant predictors; peritonitis approached significance (P=0.06).
Conclusions:
- Free fluid on CT, elevated BUN and creatinine, a BUN/Cr ratio >30, and vomiting/feeding intolerance are predictive of a pathologic etiology of PI in tube-fed patients.
- These factors can help stratify patients for closer monitoring or immediate surgical evaluation.
- This study provides valuable insights for managing PI in the context of enteral nutrition.
Abstract:
Pneumatosis intestinalis (PI) identified on computed tomography (CT) suggests an underlying pathology including bowel ischemia. Patients receiving tube feeds can develop PI, potentially requiring surgical intervention. We identify clinical factors in PI to predict those that may be safe to observe versus those that need immediate intervention. We retrospectively reviewed patients from a single institution from 2008 to 2016 with CT findings of PI and an enteric feeding tube. Patients who had not received tube feeds within one week of the CT were excluded. We analyzed clinical, operative, and outcome data to differentiate benign from pathologic outcomes. P values < 0.05 were set as significant. Forty patients were identified. We classified 24 as benign (no intervention) and 16 as pathologic (requiring intervention). A pathologic outcome was demonstrated for free fluid on CT [odds ratio (OR) = 5.00, confidence interval (CI) 1.23-20.30, P = 0.03)], blood urea nitrogen (BUN) elevation (OR = 8.27, CI 1.53-44.62, P = 0.01), creatinine (Cr) elevation (OR = 5.00, CI 1.27-19.62, P = 0.02), BUN/Cr ratio >30 (OR = 8.57, CI 1.79-40.98, P = 0.006), and vomiting/feeding intolerance (OR = 9.38, CI 1.64-53.62, P = 0.01). Bowel function within 24 hours of the CT, bowel dilatation (small ≥ 3 cm; large ≥6 cm), and lactic acidemia were not significant. Peritonitis was only seen in pathologic states, but this did not reach statistical significance (P = 0.06). This represents the largest single-center retrospective analysis of tube feeding-induced PI to date. The presence of free fluid on CT, BUN and Cr elevation, BUN/Cr >30, vomiting/feeding intolerance and peritonitis were predictive of a pathologic etiology of PI.
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