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Pneumatosis intestinalis: a review
1Department of Radiology, University of Colorado Health Sciences Center, Denver, USA.
Radiology
|April 8, 1998
Summary
Pneumatosis intestinalis, or bowel gas, has diverse causes ranging from life-threatening bowel necrosis to subtle mucosal disruptions. Differentiating these causes using clinical and imaging findings is crucial for appropriate management.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Pathology
Background:
- Pneumatosis intestinalis (PI) is characterized by the presence of gas within the bowel wall.
- Understanding the pathogenesis of PI has evolved, with several theories proposed.
- Clinical presentation and imaging findings are key to diagnosis and management.
Purpose of the Study:
- To review the changing paradigms in the understanding of pneumatosis intestinalis pathogenesis.
- To outline the major clinical and diagnostic imaging considerations for PI.
- To differentiate between life-threatening and transient causes of PI.
Main Methods:
- Literature review of existing theories and clinical observations regarding PI.
- Analysis of clinical scenarios and diagnostic imaging findings associated with PI.
- Categorization of PI causes based on clinical severity and underlying mechanisms.
Main Results:
- Four major clinical and diagnostic imaging considerations for PI were identified.
- Life-threatening causes include bowel necrosis (ischemia, infarction, necrotizing enterocolitis, neutropenic colitis, volvulus, sepsis) and emphysematous gastritis.
- Other causes involve mucosal disruption (obstruction, ulceration, trauma, iatrogenic), increased mucosal permeability in immunocompromised patients, and pulmonary conditions.
Conclusions:
- Effective management of PI hinges on accurate differentiation of its diverse causes.
- Clinical and imaging findings are paramount in distinguishing emergent conditions from more benign forms.
- Some cases of PI may remain cryptogenic, highlighting the need for continued research.
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