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The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review

Gennaro Perrone1, Mario Giuffrida2, Valentina Donato2

  • 1Department of Emergency Surgery, Maggiore Hospital, 43126 Parma, Italy.

Journal of Personalized Medicine
|February 23, 2024
PubMed

Insights

Pneumatosis intestinalis management is complex. A "watch and wait" approach is often best, reserving surgery for unstable patients or those with suspected bowel ischemia, necrosis, or perforation.

Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Radiology

Background:

  • Pneumatosis intestinalis is a radiological finding with unclear causes.
  • Current protocols for surgical intervention are lacking.

Purpose of the Study:

  • To review the literature on emergency surgery for pneumatosis intestinalis.
  • To identify factors guiding surgical intervention in pneumatosis intestinalis.

Main Methods:

  • Systematic review of literature adhering to PRISMA criteria.
  • Searched Medline and PubMed for articles from January 2010 to March 2022.
  • Included studies reporting on emergency surgery, pneumatosis coli, and pneumatosis intestinalis.

Main Results:

  • 1673 patients were analyzed; average age was 67.1 years.
  • Etiology was unknown in 47.9% of cases.
  • Hemodynamic instability (14.7%) correlated with bowel ischemia, necrosis, or perforation (p=0.019). Conservative management was used in 49.2%, surgery in 36.9%. Surgery was indicated for unstable patients with signs of ischemia, elevated lactate, or portal venous gas (PVG) (p=0.0026). 155 surgeries revealed no pathological findings.

Conclusions:

  • Patient management requires consideration of multiple variables.
  • Identifying patients who will benefit from surgery remains challenging.
  • A 'watch and wait' strategy is reasonable, with surgery reserved for unstable patients or those with high suspicion of complications.
Abstract

Keywords:
emergencypneumatosis cystoides intestinalisportal vein gasradiologysurgery

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