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Teasing out factors differentiating pathologic from benign pneumatosis intestinalis.

Julia Song1, Biqi Zhang, David Mahvi

  • 1From the Harvard Medical School (J.S., B.Z., D.M., T.D., R.A.); Center for Surgery and Public Heath, Brigham and Women's Hospital (J.S., M.S., M.C.-A., T.D., R.A.); Department of Surgery (J.S., B.Z., D.M., M.S., M.C.-A., T.D., R.A.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (M.S.), Yale New Haven Hospital, New Haven, Connecticut; and Memorial Sloan Kettering Cancer Center (D.M.), New York City, New York.

The Journal of Trauma and Acute Care Surgery
|February 13, 2025
PubMed
Summary

Pneumatosis intestinalis (PI) can be serious. A new nomogram using portal venous gas, multisegment PI, vasopressor use, peritonitis, leukocytosis, and end organ injury helps predict severe cases and guide surgical decisions.

Keywords:
Pneumatosis intestinaliscomputed tomographynomogram

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Radiology

Background:

  • Pneumatosis intestinalis (PI) is a rare radiographic finding with unclear management guidelines.
  • Distinguishing benign from severe PI is challenging due to limited evidence.
  • Predictors of severe PI require identification to guide clinical decisions.

Purpose of the Study:

  • To identify key predictors of pathologic (severe) pneumatosis intestinalis.
  • To develop a tool for predicting the likelihood of severe PI.
  • To aid in surgical decision-making for patients with PI.

Main Methods:

  • Retrospective cohort study of 334 adult patients with radiographic evidence of PI.
  • Exclusion of patients with comfort care or concurrent vaso-occlusive processes.
  • Definition of pathologic PI as ischemic/perforated bowel or death before surgery.

Main Results:

  • 27% of patients underwent exploratory laparotomy; 65% of those had ischemic/perforated bowel.
  • Pathologic PI was identified in 69 patients (laparotomy or pre-operative death).
  • Key predictors identified: portal venous gas, multisegment PI, vasopressor use, peritonitis, leukocytosis, and end organ injury.

Conclusions:

  • A nomogram incorporating identified predictors can estimate the probability of pathologic PI.
  • This nomogram may assist clinicians in making informed surgical decisions.
  • Further validation of the nomogram is warranted for clinical application.